湖北省新农合单病种付费实施效果研究

发布时间：2018-04-10 01:05

本文选题：新型农村合作医疗　切入点：单病种　出处：《湖北中医药大学》2014年硕士论文

【摘要】：目的 (1)了解调查地区新农合运行情况,以及单病种付费在病种选择、费用标准制定、补偿机制方面的实施情况。 (2)调查单病种付费的实施对医务人员及患者的影响及其评价。 (3)探究调查地区单病种付费运行中存在的问题及相关配套制度。 (4)提出完善单病种付费的建议。方法 (1)文献研究利用中国知网、万方数据库、重庆维普、pubMed等数据库,政府及医疗机构官方网站和相关统计年鉴,以及百度百科、百度文库、维基百科等网络资源,总结国内外关于支付方式效果研究,尤其是我国新农合单病种付费的研究文献。 (2)现场调查研究为了更加全面、深入地分析湖北省新农合单病种付费的实施效果,本研究根据典型抽样的方法,在湖北省选择武汉江夏区、当阳市、宣恩县作为调查地点。对当地新农合经办机构、定点医疗机构、患者进行现场访谈和调查问卷,了解新农合按病种付费在当地的开展及运行情况。 (3)重要知情人访谈访谈对象：调查地区新农合经办机构相关负责人、医疗机构管理者、临床医护人员代表。访谈内容：’新农合单病种病种选择的依据、单病种付费标准,政策是如何宣传和开展的,在实施中遇到哪些问题和困难,探讨相关解决途径与方案。 (4)对比分析法对上述3个地区新农合按病种付费在病种选择、单病种费用标准的制定、实施效果等方面进行比较分析,总结各自的实施情况、遇到的困难、拟采取的措施。结果 (1)调查地区新农合发展较好,近年来参合人数、参合率、筹资水平逐年提高。 (2)单病种付费项目确实对控制医疗费用的不合理增长起到了一定作用,对医疗质量的影响有待研究,新农合经办机构也采取了系列措施监督医疗机构。 (3)医务人员对单病种付费项目的知晓度和接受程度较高,同时也认为单病种付费存在减低医疗服务质量风险。 (4)患者主要从经办机构驻村宣传以及医院宣传等途径知晓单病种付费,对整个单病种付费项目比较满意,认为减轻了家庭就医经济负担,同时希望有关部门对定点医院加强管理和监督。结论 (1)完善定额支付标准,修正标准临床路径 (2)完善我国单病种付费医疗质量评价体系 (3)提高需方的知晓率和医务人员的积极性 (4)加强对医院的监督与信息公开 (5)新农合支付方式改革时应积极探索混合支付方式
[Abstract]:Purpose(1) to understand the operation of NCMS in the investigation area, and the implementation of single-disease payment in the aspects of disease selection, cost standard formulation and compensation mechanism.(2) to investigate the effect and evaluation of single-disease payment on medical staff and patients.3) to explore the problems existing in the operation of single-disease payment in the investigation area and related supporting systems.4) put forward the suggestion of perfecting the payment of single disease.Method1) Literature studyUsing such databases as China.com. com, Wanfang Database, Chongqing Weipu pubMed, the official websites of government and medical institutions and related statistical yearbooks, as well as online resources such as Baidu Encyclopedia, Baidu Library, Wikipedia, etc.This paper summarizes the domestic and international research on the effect of payment methods, especially the research literature on the payment of single disease of new agricultural cooperation in China.Field investigation and studyIn order to analyze the effect of payment for single disease in Hubei province, this study selected Jiangxia District, Dangyang City and Xuanen County in Hubei Province as the investigation sites according to the typical sampling method.The local NCMS agencies, designated medical institutions and patients were interviewed and investigated in order to understand the development and operation of NCMS by disease type.3) interviews with important insidersInterview subjects: the responsible persons of the new rural cooperative agencies, the managers of the medical institutions, and the representatives of the clinical medical staff.The contents of the interview were as follows: 1. The basis of selection of single disease species in New Rural Cooperation, the standard of single disease payment, how to propagate and carry out the policy, the problems and difficulties encountered in the implementation, and the relevant solutions and solutions.Comparative analysisThis paper makes a comparative analysis on the selection of disease species, the establishment of cost standard for single disease species and the effect of implementation in the three areas mentioned above, and summarizes the implementation situation, difficulties encountered and measures to be taken.ResultIn recent years, the number of participants, the rate of participation and the level of financing have increased year by year.(2) the single disease payment project does play a certain role in controlling the unreasonable increase of medical expenses, and the influence on medical quality needs to be studied. The new rural cooperative agency has also taken a series of measures to supervise medical institutions.3) the medical staff have a higher degree of knowledge and acceptance of the single disease payment item, and it is also considered that the single disease payment has the risk of reducing the quality of medical service.(4) patients are aware of the payment of single disease mainly from the channels of village propaganda and hospital publicity, and are satisfied with the payment project of the whole single-disease category, and think that the financial burden of family medical treatment has been alleviated.At the same time, I hope the relevant departments to strengthen the management and supervision of designated hospitals.Conclusion1) improve the standard of quota payment and revise the standard clinical pathway2) perfecting the quality evaluation system of paid medical treatment for single disease in China3) improve the awareness of the demand side and the enthusiasm of the medical staff(4) strengthening the supervision and information disclosure of hospitals5) when the new rural cooperative payment mode is being reformed, the mixed payment method should be actively explored.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R197.1;F842.684;F323.89

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