完善上海市医保总额预付制研究

发布时间：2018-02-03 11:34

本文关键词： 总额预付制感知调查综合评估完善策略　出处：《上海工程技术大学》2016年硕士论文　论文类型：学位论文

【摘要】：总额预付制是一种从供给层面控制医疗费用的工具。相较于其他支付方式,总额预付制因具有最佳的控制费用效果而倍受青睐,上海市从2002年开展总额预付试点,并很快全面推广到所有公立医院。然而,制度在控制费用的同时,却面临着诸多困境。因此,有必要对上海总额预付制实施情况做以评估和修正,以适应民情和“新医改”的需要。论文主要分四大部分、七个章节进行阐述。第一章和第二章为第一部分,是整篇论文的研究基奠。开篇介绍了选题的背景意义、研究框架和方法等,通过第二章对相关概念、理论支撑和研究综述的梳理,确定了论文的研究方向。第二部分为第三章、第四章,陈述上海总额预付制的发展沿革及制度试点以来的具体做法,并从医患双方的感知调查中洞悉制度推行中积极经验和运行现状。第三部分即论文第五章,主要从中观维度剖析制度实施情况。依据公共政策评估标准和制度设计初衷,从制度效果(费用控制、受益程度)、实施效应(参保人对医疗服务质量的回应、资源配置公平性)和资源配置效率三个维度进行综合评估,揭露制度运行发展的障碍和问题。第四部分为第六章和第七章,基于以上政策做法和定量模型的推演,结合典型国家的总额预付制的比较分析,总结出独特之处和可复制的经验,以上海市医保实际情况为基准,提出完善医保总额预付制的具体策略和对策建议。论文的创新之处在于将宏观视角的政策研究、微观视角的感知调查、以及中观视角的制度评估相结合,从政策演变和实证评估两个维度对总额预付制度的运行现状进行深度解剖。
[Abstract]:The total prepaid system is a tool to control medical expenses from the supply level. Compared with other payment methods, the total prepaid system is favored for its optimal control effect. Since 2002, Shanghai has carried out the pilot project of total advance payment, and has been extended to all public hospitals soon. However, the system is facing many difficulties while controlling expenses. It is necessary to evaluate and revise the implementation of Shanghai's total prepaid system in order to meet the needs of the people and the "new health care reform". The paper is mainly divided into four parts, seven chapters to elaborate. The first and second chapters are the first part. The first chapter introduces the background significance of the topic, research framework and methods, through the second chapter of the related concepts, theoretical support and research overview of the comb. The second part is the third chapter, chapter 4th, which describes the development of the Shanghai total advance system and the system of practice since the pilot. And from the perception of both doctors and patients survey insight into the implementation of the system in the positive experience and operational status. The third part is the paper 5th chapter. According to the evaluation standard of public policy and the original intention of system design, from the system effect (cost control, benefit degree, implementation effect) (the response of the insured to the quality of medical service. The equity of resource allocation) and the efficiency of resource allocation are comprehensively evaluated to expose the obstacles and problems in the development of the system. Part 4th consists of 6th chapters and 7th chapters. Based on the above policy practices and quantitative models, combined with the comparative analysis of the total prepaid system in typical countries, the unique and replicable experience is summarized, which is based on the actual situation of medical insurance in Shanghai. The innovation of this paper is to combine the policy research from the macro perspective, the perception survey from the micro perspective, and the institutional evaluation from the meso perspective. From the two dimensions of policy evolution and empirical evaluation, the operating status of total advance payment system is deeply dissected.
【学位授予单位】：上海工程技术大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：F842.684;R197.1

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