基于公立医院改革的军队医院费用补偿机制研究

发布时间：2018-05-30 20:39

本文选题：公立医院 + 军队医院　；参考：《第二军医大学》2017年硕士论文

【摘要】：研究目的公立医院补偿机制是我国深化医药卫生体制改革的核心和关键,军队医院作为特殊的公立医院,要顺应医疗改革的政策,但却没有针对军队医院补偿机制的政策,迫使军队医院必须寻求自己的出路。本研究在公立医院改革补偿机制的背景下,采用对两所军队医院医务人员面对面访谈、四所军队医院患者问卷调查和其中一所访谈军队医院医疗服务信息三个途径获取数据,对其进行整理和分析,提出军队医院的费用补偿机制及执行措施,为新医改下军队医院的正常运转、持续发展和改革设计提供理论依据和数据支撑。将本研究结果和主课题相结合,探索有效的补偿途径,降低试错成本,更合理和高效地完善补偿机制。资料与方法1、资料来源:政策文件和研究文献分别来源于网站检索和电子期刊数据库,访谈资料来源于对两所军队医院20名医务人员的访谈,问卷调查资料来源于四所军队医院283名就诊患者的现场作答,2010年07月01日-2013年06月30日X军队医院医疗服务信息,提取于其中一所访谈军队医院军卫1号系统。2、研究方法:首先,通过文献检索进行理论分析和综合述评,撰写访谈提纲和设计调查问卷;其次,开展面对面的访谈和现场实地调查,搜集相关信息和数据,并利用Epidata3.1、spss18.0进行整理、录入和分析;第三,利用Excel2007、SAS9.2统计软件,对收集到的军队医院军地患者的医疗服务信息进行整体数据和各项医疗服务参数分布的分析;最后,采用比较分析法探讨与军队医院相匹配的费用补偿机制。研究结果1、通过访谈发现,军队医院的医务工作者一致赞成“取消药品加成”政策,但认为取消药品加成将降低军队医院的收入和为军队官兵服务的水平,造成军队和地方的人才进一步流失,影响军队医院的整体发展。2、问卷调查表明,药品费用占门诊费用70%以上,患者担心取消药品加成后其它费用会增加。七成以上的被调查者接受新门诊收费标准,新门诊收费标准将增加主任医师和知名专家的门诊量,近四成的被调查者依然认为药品价格较高且因药品价格过高而感到不理解和无奈。3、医疗数据揭示,某军队医院的门诊占总诊疗人次的91.7%(2105182人次),住院占总诊疗人次的8.3%(189848人次),84.3%诊疗人次为地方人员。对外医疗收入中,药品收入占39.3%,医疗服务收入占60.7%,药品占比逐年下降,药品降幅大于医疗服务收入;医疗服务收入中,检查检验、治疗和材料收入占比较高。门诊对外医疗中,自费人员诊疗人次(60.8%)和费用(57.9%)占比最高;病人次均医药费低于问卷调查医院;收入逐年上升,药品收入占48.6%,医疗服务收入占51.4%。住院对外医疗中,三年间总住院人次先增后减,地方住院患者占89.3%,自费人次占50.5%,地方医保病人占比上升到38.8%;住院收入先涨后降,平均住院天数和次均住院费逐年下降,每床日均住院费用逐年上升;药品收入占37.5%,医疗服务收入占62.5%;医疗服务收入中,材料费占比最高,其次是检验检查和治疗收入。药品支出占全院支出最高(49.7%),其次是材料支出(28.7%);人力成本支出中,绩效补贴占62.4%,工资占17.9%。结论和建议目前军队医院的补偿主要存在缺乏地方政府补偿、医疗服务价格体系不合理、医保补偿机制不完善、军队医院人才流失、患者对改革可能带来的不良后果心存疑虑等问题。为推动我国军队医院补偿机制的完善,应当因地制宜的建立按量补偿机制,按照医院的级别和规模来进行补偿;通过增设医事服务费,调整医疗服务收费,建立合理的价格体系;改进目前医疗保险的支付体系,完善医保制度,减轻患者负担;及时制定给予聘用制工作人员的补偿措施,加大补偿力度;加强相关政策的宣传和强力监督。
[Abstract]:The compensation mechanism of public hospitals is the core and key of deepening the reform of the medical and health system in our country. As a special public hospital, military hospitals should comply with the policy of medical reform, but there is no policy against the compensation mechanism of military hospitals, which compels military hospitals to seek their own way out. This research is made in public hospital reform and compensation. Under the background of the mechanism, two medical personnel in military hospitals were interviewed face-to-face, four military hospital patients questionnaire survey and one interview with military hospital medical service information were used to obtain data. The data were collected and analyzed, and the compensation mechanism and implementation measures of military hospitals were put forward, for the military hospitals under the new medical reform. The theoretical basis and data support are provided for normal operation, continuous development and reform design. The results of this study are combined with main subjects to explore effective compensation ways, reduce the cost of trial and error, and improve the compensation mechanism more reasonably and efficiently. Data and methods 1, source of information and research documents are derived from web search and electronic period, respectively. The interview data came from interviews with 20 medical personnel in two military hospitals. The questionnaire survey data came from 283 medical patients in four military hospitals, and the medical service information of X military hospital on 06 month 30 of 2010 -2013 was extracted from one of the military hospital military and Wei No. 1 system.2, which was interviewed. First, through the literature search for theoretical analysis and comprehensive review, write interview outline and design questionnaire; secondly, carry out face-to-face interviews and field investigation, collect relevant information and data, and use Epidata3.1, SPSS18.0 to organize, input and analysis; third, the use of Excel2007, SAS9.2 statistical software, to collect the army Analysis of the overall data and the distribution of medical service parameters in the medical service information of the army and land patients in the hospital. Finally, the comparative analysis method was used to discuss the cost compensation mechanism matched with the military hospital. Results 1, through interviews, it was found that the medical workers in the military hospital agreed that the policy of "canceling the addition of drugs" was unanimous. The abolition of drug addition will reduce the income of military hospitals and the level of service for military officers and soldiers, resulting in the further loss of military and local personnel, affecting the overall development of military hospitals.2. The questionnaire survey shows that the cost of medicine accounts for more than 70% of the out-patient expenses, and the patients fear that the other costs will increase after the abolition of drugs. More than 70% are investigated. The new outpatient charge standard, the new outpatient charge standard will increase the outpatient quantity of the chief physician and the well-known expert, nearly 40% of the respondents still think that the price of the drug is high and the drug price is too high, it is not understood and helpless.3. Medical data reveal that the outpatient of a military hospital accounts for 91.7% (2105182 people) of the total number of patients. The hospital accounted for 8.3% (189848 person times) of total diagnosis and treatment. 84.3% of the medical treatment income, medical income accounted for 39.3%, medical service income accounted for 60.7%, drug proportion decreased year by year, drug decline was greater than medical service income; medical service income, inspection and inspection, treatment and material income accounted for more. Outpatient medical treatment, outpatient medical treatment, The person time (60.8%) and the cost (57.9%) accounted for the highest rate; the medical expenses of the patients were lower than the questionnaire survey Hospital; the income increased year by year, the drug income accounted for 48.6%, the medical service income accounted for the 51.4%. inpatient medical treatment, the total number of inpatients in the three years was first increased and then decreased, the local inpatients accounted for 89.3%, and the patient accounted for 50.5%, and the local medical insurance patients. The proportion of the occupation was up to 38.8%, the hospitalization days and the average hospitalization expenses decreased year by year, the average daily hospitalization expenses of each bed increased year by year, the medical income accounted for 37.5%, the medical service income accounted for 62.5%, the medical service income, the material cost was the highest, the second was the inspection and treatment income, and the drug expenditure accounted for the highest expenditure (49.7). The second is material expenditure (28.7%); in the human cost expenditure, the performance subsidies account for 62.4%, and the salary accounts for the 17.9%. conclusion and the suggestion that the compensation of the military hospital is mainly lack of local government compensation, the price system of medical service is not reasonable, the medical insurance compensation mechanism is not perfect, the brain drain of the military hospital and the adverse consequences that the patients may bring to the reform In order to improve the compensation mechanism of military hospitals in our country, we should build up the compensation mechanism according to the level and scale of the hospital according to the local conditions, adjust the medical service charge, adjust the medical service charge, establish a reasonable price system, improve the current medical insurance payment system, and improve the medical insurance system. In order to reduce the burden of patients, we should make timely compensation measures for the staff of the appointment system, increase the intensity of compensation, and strengthen publicity and strong supervision of relevant policies.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R82

【参考文献】