榆次纺配社区卫生服务承接医疗保险的现状研究

发布时间：2018-04-19 13:03

本文选题：社区卫生 + 社会医疗保险　；参考：《山西财经大学》2013年硕士论文

【摘要】：社区卫生服务是能提供预防、健康教育、妇幼保健、慢性病康复等功能的基层医疗卫生服务；社区卫生服务是公益性的基层卫生服务。其发展的根本目的就是让参保职工、还包括参加其他类型保险的居民能公平的享受医疗卫生服务。其广覆盖、低成本、便利性的特点让社区居民足不出户就能解决小病、常见病，，进行慢性病康复。社区卫生服务与医疗保险相辅相成，共同发展。社会医疗保险一方面为社区卫生提供政策引导，比如，限定了纺配社区卫生服务站必须管辖1万人及以上；另一方面，社会医疗保险还给社区卫生提供了资金保障。社区卫生服务既保护了人才资源，又促进了社会的和谐稳定。在社区卫生服务就诊所花费的医疗费用低于大医院，如果在社区解决小病、常见病就能减少参保居民的医疗费用支出，也能降低社会医疗保险统筹基金的支付压力。社区卫生服务承接社会医疗保险的路径就是通过医疗保险定点审核后，向社区参保居民提供医疗服务。社区卫生服务与医疗保险的承接方式就是通过医保患者，并且依靠医保病种和卫生服务站站内医保收入来体现。榆次纺配社区卫生服务站在经过榆次区医保中心医保定点审核通过后，向纺配社区的居民提供基本医疗卫生服务，包括为居民建立健康档案、进行健康教育讲座、关注高危人群，即经常吸烟且缺乏锻炼的人群、妇幼保健、定期专家咨询、慢性病管理。虽然在降低医疗服务成本、提高服务水平、方便群众方面取得一定的成果，但是仍然在制度配套和卫生服务站自身建设方面存在一定的问题，必须通过完善法律制度、加大制度建设和政府财政扶持力度、加强社区卫生自身建设四个方面来促进榆次纺配社区卫生服务承接医疗保险的发展。
[Abstract]:Community health service is a primary health service which can provide prevention, health education, maternal and child health care, rehabilitation of chronic diseases and so on, and community health service is a basic health service of public welfare.The fundamental goal of the development is to provide equal access to health services for insured workers and other types of insurance.Its wide coverage, low-cost, convenient characteristics enable community residents to solve minor diseases, common diseases, chronic disease rehabilitation.Community health service and medical insurance complement each other and develop together.On the one hand, social medical insurance provides policy guidance for community health, for example, it limits that the spinning community health service station must have jurisdiction over 10,000 people and more; on the other hand, social medical insurance also provides financial security for community health.Community health service not only protects human resources, but also promotes social harmony and stability.The cost of medical treatment in community health service is lower than that in large hospital. If we solve the minor disease in the community, the common disease can reduce the medical expenses of the insured residents, and can also reduce the payment pressure of the social medical insurance plan fund.The path of community health service to undertake social medical insurance is to provide medical service to the residents of community insurance after the fixed-point audit of medical insurance.The way of undertaking community health service and medical insurance is through medical insurance patient, and it depends on medical insurance disease and medical insurance income in health service station.The Yuci spinning Community Health Service Station has provided basic medical and health services to the residents of the spinning and distribution community after it has been approved by the Yuci District Medical Insurance Center for medical insurance, including setting up health files for the residents and conducting health education talks.Focus on high-risk groups, that is, frequent smokers and lack of exercise, maternal and child health care, regular expert consultation, chronic disease management.Although certain achievements have been made in reducing the cost of medical services, improving the service level, and making it convenient for the masses, there are still some problems in supporting the system and in the construction of the health service station itself. We must improve the legal system.Strengthen the system construction and the government financial support, strengthen the community health self-construction four aspects to promote the Yuci textile community health service to undertake the development of medical insurance.
【学位授予单位】：山西财经大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R197.1;F842.684

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