本文關鍵詞： 乳腺癌 住院費用 補償比 城鎮(zhèn)職工醫(yī)療保險 城鎮(zhèn)居民基本醫(yī)療 保險 新型農村合作醫(yī)療　出處：《山東大學》2015年碩士論文　論文類型：學位論文

【摘要】：研究背景改革開放30余年,社會經(jīng)濟飛速發(fā)展,醫(yī)療事業(yè)也取得了長足的進步。然而,“看病難,看病貴”的問題,在全國仍較為普遍。黨中央、國務院高度重視醫(yī)療民生問題,逐步推進醫(yī)療衛(wèi)生體制改革,建立醫(yī)療保障體系。1998年在全國范圍普及實行城鎮(zhèn)職工醫(yī)療保險制度(以下簡稱“城職保”),主要惠及城鎮(zhèn)職工。2003年逐步推行新型農村合作醫(yī)療制度(以下簡稱“新農合”),主要關注農村居民的醫(yī)療保障。自2007年開始,逐步實行城鎮(zhèn)居民基本醫(yī)療保險制度(以下簡稱“城居�！�),主要保障城鎮(zhèn)非從業(yè)居民。全民醫(yī)保的框架(包含城鎮(zhèn)職工、農民、城鎮(zhèn)非從業(yè)人員)已經(jīng)基本搭建完成。研究目的本文首先對蚌埠市三種基本醫(yī)保制度進行了梳理；其后分析了某醫(yī)院三種不同醫(yī)保制度乳腺癌患者住院費用及其差異；最后比較了三種醫(yī)保制度對乳腺癌患者住院費用補償水平。研究為相關部門完善醫(yī)保政策提供理論參考依據(jù)。研究方法以在2008年至2013年某三甲醫(yī)院就診的本地級市的城職保、城居保以及新農合三類醫(yī)保乳腺癌患者為研究對象,提取患者住院費用的具體相關信息。分析三種不同醫(yī)�；颊咦≡嘿M用的差別。本研究擬采用文獻復習與定量調查的方法,查閱相關的政策資料以及統(tǒng)計數(shù)據(jù),獲取信息。資料的來源為2008-2013年蚌埠市及各縣、區(qū)醫(yī)保政策文件、醫(yī)院住院患者的病例首頁信息系統(tǒng)、費用信息系統(tǒng)、醫(yī)院醫(yī)保辦費用信息系統(tǒng)主要結果1、城職保、城居保以及新農合三組中西藥費所占比例均最高(48.9%-51.3%),大致為總費用的一半。其次分別為診斷費(12.1%～12.7%)、治療費(11.6%～12.8%)、手術費(10.0%～10.4%)、麻醉費(4.1%～5.2%)、中藥費、其他。2、住院總費用、診斷費、治療費、西藥費、中藥費、麻醉費在三組間有差異,P值分別為：0.000、0.021、0.000、0.000、0.003、0.016。手術費在三組間無顯著差異,P=0.148。其中住院總費用：城職�；颊呓M(15781.6元)及城居保患者組(16474.2元)要顯著高于新農合患者組(13606.2元)；其中治療費：城職保患者組(1962.0元)及城居�；颊呓M(2113.1元)要顯著高于新農合患者組(1575.7元)；其中西藥費：城職�；颊呓M(8088.2元)及城居保患者組(8146.2元)要顯著高于新農合患者組(6653.4元)。3、不同醫(yī)�；颊叽尉≡禾鞌�(shù)差異不大(F=1.702,P=0.183), 但日均住院費用差異明顯(F=16.543,P=0.000),城職保組為1142.6元,城居保組為1111.0元,新農合組為953.6元。城職保日均住院費用最高,新農合日均住院費用最低。這可能與城市居民基本消費能力較高以及報銷比例較高有關。4、從次均總費用來看,城職保、城居保與新農合分別為15781.6元、16474.2元、13606.2元,城居保略高于城職保,遠高于新農合,差異有統(tǒng)計學意義(P=0.000)；從次均補償來比較,新農合(6093.8元)最低、城居保(8730.8元)其次,城職保(11828.9元)最高,三者差異具有顯著性(P=0.000)；從三類醫(yī)保的次均個人支付來看,城居保(7743.4元)最高,新農合(7512.5元)其次,城職保(3952.6元)最低,三者差異具有統(tǒng)計學意義(P=0.000)；新農合實際補償比44.8%,最低。城居保實際補償比54.0%,居中。城職保實際補償比75.0%,最高。三者具有顯著性差異(P=0.000)。結論與建議1、醫(yī)保部門及醫(yī)療機構應重點監(jiān)控城職保及城居保住院費用支出,控制住院費用上漲的速度。醫(yī)療機構要繼續(xù)優(yōu)化住院費用結構,其中尤其要控制住院天數(shù)及藥品比例。2、提高醫(yī)務人員的勞務價值在住院費用的構成比。3、政府應加大新農合財政投入,擴大覆蓋面,改革城居保及新農合醫(yī)保支付模式,提高實際報銷比例,于此同時進一步提高醫(yī)療服務質量,促進衛(wèi)生服務公平性。4、加強醫(yī)療保險管理,探索研究多元化的繳付費模式。改進醫(yī)療保險服務,方便參保群眾。
[Abstract]:On the background of 30 years of reform and opening up, the rapid development of social economy, medical industry has made considerable progress. However, the "difficult and expensive" problem in the country is still relatively common. The Party Central Committee, the State Council attaches great importance to the medical problems of people's livelihood, gradually advancing the reform of health system, the establishment of medical security system in China.1998 the scope of implementation of universal medical insurance system for urban employees (hereinafter referred to as the "city job security"), the main benefit of urban workers.2003 years of gradual implementation of the new rural cooperative medical system (NCMS), the main concern of rural residents medical security. Since the beginning of 2007, gradually implement the basic medical insurance system for urban residents (hereinafter referred to as "City home insurance"), mainly to protect the urban non employed residents. The framework of universal health insurance (including urban workers, farmers, urban non practitioners) have been built. Basic research purpose This paper summarizes three kinds of basic medical insurance system in Bengbu city; the subsequent analysis of a hospital in three different health care system for patients with breast cancer hospitalization expenses and difference; finally compares three kinds of medical insurance system on the cost of compensation level in patients with breast cancer. Research for the relevant departments to improve medical insurance policy to provide theoretical basis for the research methods. In 2008 to 2013 in a hospital from local level city job security, city habitat protection and new three kinds of Medicare breast cancer patients as the research object, the specific information related to the hospitalization expenses of patients with extraction. Analysis of three kinds of hospitalization expenses of different Medicare patients. This study adopted the methods of literature review and quantitative survey access to information, access to relevant policy information and statistical data. The data source for Bengbu city and county 2008-2013, district hospital inpatient medical insurance policy documents Case of home information system, cost information system, the main results of hospital medical insurance office information system costs 1, city job security, the city ranks three and the new rural cooperative medicine group had the highest proportion (48.9%-51.3%), roughly half of the total cost. Then the diagnosis fee (12.1% ~ 12.7%), the treatment fee (from 11.6% to 12.8%), surgery (10% ~ 10.4%), anesthetic fee (4.1% ~ 5.2%), Chinese medicine fees, other.2, the total cost of hospitalization, diagnosis, treatment costs, the cost of Western medicine, Chinese medicine fee, anesthetic fee has difference between the three groups, P values were: 0.000,0.021,0.000,0.000,0.003,0.016. surgery had no significant difference between the three groups, P=0.148. of which the total hospitalization expenses: city job security group (15781.6 yuan) and city home insurance group (16474.2 yuan) was significantly higher than that of NCMS patients (13606.2 yuan); the treatment fee: city job security group (1962 yuan) and city home insurance group (2113.1 yuan) to show Than that of NCMS patients (1575.7 yuan); the medicine charge: city job security group (8088.2 yuan) and city home insurance group (8146.2 yuan) was significantly higher than that of NCMS patients (6653.4 yuan) of.3, the average hospitalization days of patients with different medical insurance differences (F=1.702, P=0.183), but the average hospitalization expenses significant differences (F=16.543, P=0.000), the city job group for 1142.6 yuan, 1111 yuan in the city group, the NCMS group was 953.6 yuan. The average daily hospitalization cost highest city job security, the NCMS hospitalization cost lowest. This may be related to the basic consumption of city residents to higher and higher proportion of reimbursement from.4, total cost city view, job security, and the new city home insurance were 15781.6 yuan, 16474.2 yuan, 13606.2 yuan, the city ranks higher than Bao slightly city job security, far higher than the NCMS, the difference was statistically significant (P=0.000); the average compensation of NCMS (6093.8 yuan), the lowest in the city Paul (8730.8 yuan) Secondly, city job security (11828.9 yuan), three with significant difference (P=0.000); from three kinds of insurance are the individual payment, the city ranks highest (7743.4 yuan), the NCMS (7512.5 yuan) Secondly, city job security ($3952.6) minimum, statistically significant difference between the three groups (P=0.000); new actual compensation ratio of 44.8%, the city ranks the lowest. The actual compensation ratio of 54%, the city center. Job security the actual compensation ratio of 75%, the highest. Three significant differences (P=0.000). Conclusions and recommendations 1, health departments and medical institutions should focus on monitoring the city job security and city home insurance hospitalization expenses, hospitalization expenses control the rate of rise. Medical institutions should continue to optimize the structure of hospital costs, especially to control the length of hospitalization and drug ratio of.2, improve the medical staff's labor value in the form of hospital costs than.3, the government should increase financial investment in expanding the coverage of new rural cooperative medical system. Reform, city home insurance and new rural cooperative medical insurance payment mode, improve the actual reimbursement ratio, at the same time, to further improve the quality of medical services, and promote the.4 health service fairness, strengthen the management of medical insurance payment fees, explore the mode research diversified. The improvement of medical insurance services, the convenience of insured people.

【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R197.3;R737.9

【共引文獻】

相關期刊論文 前7條

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