基于系统动力学的大连市医疗保险费用控制研究

发布时间：2018-04-12 13:46

本文选题：社会医疗保险 + 系统动力学　；参考：《大连工业大学》2014年硕士论文

【摘要】：自20世纪以来，，随着经济、社会、人口的发展变化以及医疗高新技术的进步，不断攀升的医疗保险费用已成为困扰各国的世界性难题。而我国自2009年新医改以来，针对如何控制医疗保险费用的不合理上涨、解决“看病难，看病贵，因病致贫”已成为当前医疗卫生体制改革中的重中之重。但因医疗保险费用控制涉及多方利益、牵一发而动全身的系统特性，需要系统性思考其控制机理。本研究通过系统动力学建模方法对医疗保险费用控制机理进行研究，意在深化我国全民医保的覆盖深度与高度，进一步降低人民看病负担，并为学术研究以及政策制定上提供理论借鉴。研究以宏观卫生系统模型、系统动力学为理论基础，通过文献归纳法、专家咨询法对大连市医保费用控制问题进行系统研究。本研究共分为五部分：第一部分阐述研究背景、意义、目的以及文献综述，并简述研究内容、技术路线等相关内容；第二、三部分对大连市医保费用控制系统进行描述性分析，并绘制出了系统边界图、大连医保控费系统概念模型图，以及以人力资源与社会保障局医疗保险管理中心为切入点的系统逻辑模型图，为构建系统动力学模型奠定了基础；第三部分以定性分析为基础，以大连市统计年鉴等二手数据作为历史数据，对医疗保险费用控制进行了定量分析，绘制出系统流图，最终导入函数表达式构建了系统动力学模型并加以检测与运行；第五部分对整个研究进行结论分析与展望，预测人均年医疗消费支出、家庭医疗消费恩格尔系数仍将持续快速上涨，预计2027年人均年医疗消费支出将达到3645.0元，家庭医疗消费恩格尔系数将上涨到3.6%。其中，医患双方督控系数和政府财政补助比例对医保费用控制影响最为显著，建议政府及人力资源与社会保障局等相关部门在医保控费政策制定中更加注重对医患双方的督控以及财政补助比例的测算。
[Abstract]:Since the 20th century, with the development of economy, society and population, as well as the progress of high and new medical technology, the rising medical insurance cost has become a worldwide problem puzzling all countries.Since the new medical reform in 2009, how to control the unreasonable increase of medical insurance costs and how to solve the problem of "difficult to see a doctor, expensive to see a doctor, and poor because of illness" has become the most important part of the current reform of the medical and health care system.But because the medical insurance expense control involves various benefits, it needs to think about its control mechanism systematically.The purpose of this study is to deepen the coverage depth and height of universal health insurance in China, and to further reduce the burden of medical treatment.And for academic research and policy formulation to provide theoretical reference.On the basis of macro health system model and system dynamics, this paper studies the cost control of medical insurance in Dalian by the method of literature induction and expert consultation.This research is divided into five parts: the first part describes the research background, significance, purpose and literature review, and briefly describes the research content, technical routes, etc.The system boundary map, the concept model diagram of Dalian medical insurance and control fee system, and the system logic model diagram based on the medical insurance management center of the Bureau of Human Resources and Social Security are drawn, which lays the foundation for constructing the system dynamics model.The third part is based on the qualitative analysis, taking the second-hand data such as Dalian Statistical Yearbook as the historical data, carries on the quantitative analysis to the medical insurance expense control, draws out the system flow chart.Finally, the system dynamics model is constructed by introducing the function expression, and the system dynamics model is tested and run. The fifth part is the conclusion analysis and forecast of the whole research, and forecasts the per capita annual medical consumption expenditure.The Engel coefficient of household health care consumption will continue to rise rapidly, with per capita annual medical expenditure expected to reach 3645.0 yuan in 2027, while the Engel coefficient of household medical consumption will rise to 3.6 yuan.Among them, the coefficient of supervision and control between doctors and patients and the proportion of government financial subsidies have the most significant influence on the cost control of medical insurance.It is suggested that the government, the Human Resources and Social Security Bureau and other relevant departments should pay more attention to the supervision and control of both doctors and patients and the calculation of the proportion of financial subsidies in the policy formulation of medical insurance and control fees.
【学位授予单位】：大连工业大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684;N941.3

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