医保单病种付费患者满意度评价体系研究

发布时间：2018-02-23 21:07

  本文关键词： 医保 单病种付费 满意度 反馈　出处：《安徽医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：研究背景 厦门市基本医疗保险于2005年7月1日起正式实行部分疾病按单病种结算，至今已有九年时间，按病种付费病种由最初的8种增至现在的21种，单病种付费在实践中不断发展完善，但是关于患者对单病种付费以及医保、医疗机构的运行及服务情况满意与否，缺乏专业可靠的评价工具，患者方的评价与建议难以得到反馈。 国外单病种付费以及国内相关研究都在一定的程度上表明，单病种付费支付方式能够控制医疗费用过快上涨、有效减少平均住院天数、使医院改进费用及服务管理、促使医院努力平衡医保费用的使用，最终改善医疗服务质量。但是这些改良或结算是否获得了患者的支持，在经济效益得到有效提高和控制的同时是否获得了预期的社会效益，仍缺乏相关研究与政策的支持。积极探索实行单病种付费的支付方式，进行医保支付方式改革，最终目标还是服务患者和广大人民群众。 研究目的 本课题研究目的在于尝试对厦门市三甲综合医院单病种付费实施的效果进行评价，试制评价工具，分析按病种付费在三甲综合医院实施中可推广借鉴的优势及存在的问题，提出完善医疗保险按病种付费方式的方案。 研究内容 (1)编制单病种满意度调查问卷，以问卷作为单病种满意度研究体系的初级工具； (2)通过调查获得厦门市单病种付费患者满意度方面的数据，掌握影响满意度的因素； (3)从获得的数据入手，分析在制度制定与实施过程中存在的问题，归纳本研究中现存的不足。 研究方法 1、文献检索，资料查阅 查阅国内外单病种付费方式满意度方面的文献，搜集本市的相关文件政策资料，了解国家以及厦门本市基本医疗保险的文件、制度、政策及单病种付费的实施方案。 2、现场调查 （1）重要知情人访谈 采用重要知情人访谈的方法，了解按病种付费制订的目标、项目的实施过程和成效，确认与满意度影响有关的因素及维度。访谈对象包括市医保中心工作人员、医保中心结算办工作人员、所调查医院行政分管院长及医保办工作人员。 （2）满意度问卷调查 通过文献查阅及专家咨询法，确定满意度相关各指标及维度，根据美国顾客满意度指数模型（ACSI）及中国医院患者满意度指数模型（CHPSI－05）的要素进行分析，编制针对单病种付费的满意度调查问卷，分为自填问卷与电话随访问卷2类，对30～40名患者进行预调查，比较并检验问卷的信度及效度，通过重测信度等指标选择合适的调查方式，，对所选问卷进行修改补充后，于所实习医院对单病种付费住院患者进行抽样调查，共300份，进行满意度问卷调查，了解患者对当前单病种付费运行状况的认知与满意度情况。研究结果与主要发现 电话随访调查较适合对单病种付费病人的满意度调查；患者的满意度评价不一，但对医技水平及责任感评价高，服务及时性及服务态度有待改善；患者及家属对单病种付费的认知程度不足，相关知识较为缺乏；患者方对单病种运行的参与程度不足，缺少正式的满意度反馈体系；提升医疗水平才是保证满意度的重点。 政策建议 对于完善单病种满意度研究的建议 1.进行联合研究，分享研究资源 2.扩展研究时间，将病种间差异纳入考量范围 3.加大宣传力度，妥善运用社会力量 对单病种付费制度本身的建议 1.建立专业的满意度评价反馈体系 2.完善当前的费用核算机制 3.加强与患者的沟通解释 4.避免院方的风险转移 5.将临床路径与单病种付费有机结合 6.细化疾病诊断分组，适时向DRGs支付方式转变
[Abstract]:Research background
The basic medical insurance in Xiamen City, the official implementation of part of the disease according to the single disease settlement in July 1, 2005, has been nine years, DRGs disease from 8 to 21 initially present, SingleDisease consummated continually, but on patients with single disease payment and medical insurance, medical service and operation the satisfaction, the lack of professional and reliable evaluation tool, evaluation and suggestion of the patient to get feedback.
Foreign SingleDisease and domestic relevant studies show that in a certain extent, single payment payment to the medical expense control is rising fast, effectively reduce the average hospitalization time, improve the cost and service management of the hospital, the hospital prompted the use of trying to balance the medical insurance cost, and ultimately improve the quality of medical service. But these improvements or whether the settlement get the patient support, effectively improve and control the economic benefits at the same time whether to obtain the desired social benefits, is still a lack of research and policy support. To actively explore the implementation of single disease payment, Medicare payment reform, the ultimate goal is to serve the patients and the broad masses of the people.
research objective
The purpose of this research is to try to tertiary comprehensive hospitals of Xiamen city SingleDisease implementation effect evaluation, trial evaluation tools, analysis the implementation of DRGs in three general hospitals can be used the advantages and existing problems, put forward to perfect the medical insurance according to the disease kinds of payment scheme.
research contents
(1) the questionnaire of single disease degree of satisfaction was compiled, and the questionnaire was used as the primary tool for the study system of the degree of satisfaction of single disease.
(2) through the survey to obtain the data of the degree of satisfaction of the single disease paid patients in Xiamen, and grasp the factors that affect the satisfaction.
(3) starting with the obtained data, the existing problems in the process of system formulation and implementation are analyzed, and the existing deficiencies in this study are summarized.
research method
1, literature retrieval, data access
Consult the literature about the satisfaction degree of the single disease payment method at home and abroad, collect relevant documents and policy information of the city, and understand the document, system, policy and implementation plan of the single disease payment of the state and the basic medical insurance in Xiamen.
2, field survey
(1) interviews with important lovers
By using the method of key informant interviews, to pay the goals set by disease, implementation process and results of the project, confirm the relevant factors and satisfaction and influence dimensions. The interviewees include city health center staff, medical insurance settlement center office staff survey, the hospital administrative Dean and medical insurance office staff.
(2) questionnaire survey of satisfaction
Through literature review and expert consultation method to determine the related indexes and satisfaction dimensions, according to the American customer satisfaction index (ACSI) and Chinese hospital patient satisfaction index model (CHPSI - 05) to analyze the factors for preparation of single transfer DRGs satisfaction questionnaire, divided into self-administered questionnaires and telephone follow-up questionnaire 2 categories. A pre survey was carried out in 30~40 patients, compare and test the reliability and validity of the scale, the test-retest reliability index were chosen to investigate the appropriate, revise the selected questionnaire after paying sampled hospitalized patients on single disease to hospitals, a total of 300, satisfaction questionnaire, cognition and satisfaction the current situation of SingleDisease operation condition of the patients understand the results and main findings.
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本文编号：1527608