我国医疗保险费用增长与控制问题研究

发布时间：2018-04-12 13:59

本文选题：医疗保险费用控制 + 支付方式改革　；参考：《山东师范大学》2014年硕士论文

【摘要】：医疗保险是在一定历史条件下，根据生产力发展水平、各方面承受能力、卫生资源状况和卫生服务提供的状况，，在国家和地区基本健康保障范围内，为全体参保人提供基本性的、必不可少的医疗服务。但是，目前医疗服务费用支出的急剧上涨已是全球性的问题，不论是发达国家还是发展中国家，医疗费用占国民生产总值比例以及占国民生产总值比例的平均增长率上涨速度都过快。高增长的医疗费用已成为各国政府一个越来越来沉重的经济负担。而我国的医疗保险体系正在逐步完善中，如果不能有效控制医疗保险费用的迅速增加，将会阻碍医疗保险体系的正常运行和健康发展，甚至会危及医疗保险体系的安全。我国医疗保险改革起步比较晚，改革的措施和方向主要参照和综合了发达国家的医疗保险制度，力图改革原有的医疗保障体制，寻找投入少，效益高、覆盖面广的医疗保障制度。而能否有效控制医疗费用过快增长，已经成为建立新型社会医疗保险制度的焦点问题，也成为维持社会稳定、完善社会主义保障体系中的重要因素。全文共分为五个部分论文的第一部分首先阐述了医疗保险费用的概念及特点，然后从医疗保险需求增加、人口老龄化加剧、疾病谱转变、城乡人口比例变化、新型医疗技术和设备的使用五方面详细分析了我国医疗费用增长现状。论文的第二部分介绍了医疗保险费用控制的含义及原则，并从四方面阐述了在我国现阶段医疗保险费用控制的重要意义。论文的第三部分从付费方式单一、临床路径发展缓慢、医疗机构及道德风险三方面列示了我国目前医疗保险费用控制存在的问题，并分别对造成问题的原因做了深入的剖析。论文的第四部分是对医疗费用增长控制的建议部分。在本部分中，笔者分别从政府职能强化、付费方式改革、完善临床路径、加强医疗机构管理、增加宣传力度倡导科学就医理念五方面提出了自身的意见和建议。在文章的最后，笔者根据多年从事医保基金工作的经验，对我国现阶段的医保个人账户和免费医疗提出了自己的一点思考和建议。论文的第五部分是结束语。
[Abstract]:Under certain historical conditions , medical insurance is an essential and essential medical service for all participants according to the development level of productive forces , the state of health resources and health services . However , the rapid increase in the expenditure of medical services has become a global problem . However , the health insurance system in our country has become a global problem .

The full text is divided into five parts

The first part of this paper first expounds the concept and characteristics of medical insurance expenses , then analyzes the present situation of medical expense growth in China from five aspects : the increase of medical insurance demand , the increase of population aging , the transformation of disease spectrum , the change of population proportion between urban and rural population , the use of new medical technology and equipment .

The second part of this paper introduces the meaning and principle of medical insurance cost control , and expounds the important meaning of medical insurance cost control in China at present .

The third part of this paper shows the existing problems of medical insurance cost control in our country from three aspects : single payment mode , slow development of clinical pathway , medical institution and moral hazard , and makes an in - depth analysis on the causes of the problems .

The fourth part of this paper is the suggestion part of medical expense growth control . In this part , the author puts forward its own opinions and suggestions from the strengthening of government function , the reform of payment mode , perfecting the clinical pathway , strengthening the management of medical institutions , increasing propaganda and advocating the concept of science . At the end of the article , the author puts forward some thoughts and suggestions on the personal account and free medical care of medical insurance in our country according to the experience of medical insurance fund work for many years .

The fifth part of the thesis is concluding remarks .

【学位授予单位】：山东师范大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684

【参考文献】