基本卫生服务包设计理论与居民医保设计需求分析研究

发布时间：2018-07-06 20:38

本文选题：卫生服务包 + 城镇居民医保　；参考：《第四军医大学》2013年博士论文

【摘要】：党中央将人人享有基本医疗卫生服务确定为全面建成小康社会的重要目标之一，建设覆盖城乡居民的包括居民基本医疗保险制度的三大基本医疗卫生制度。论文旨在通过探讨建立适合城镇居民需要的“基本卫生服务包”理论方法，分析城镇居民对医疗保险的认知、需求、支付意愿和支付能力，提出设计符合我国国情的城镇居民医保卫生服务包的建议，为我国建立完善城乡一体、预防、医疗、保健一体的基本医疗卫生制度和医疗卫生体系提供依据。基本卫生服务包设计的最主要问题是如何提高卫生服务产品的效率，需要分析其成本和可利用的资源，然后调整包含的内容，直到包含的项目内容和可供利用的资源水平达到一个平衡。成本效果分析是一种使有限的资源得到最有效利用的技术，分析评价健康项目利用的资源和获得健康效益的方法，通过使用成本效果分析，决策者可以从这些项目中进行选择。虽然成本效果分析不能告诉我们社会应该从事哪种健康服务，但是提供了一个关于健康项目的效果和效率的信息的框架。有了这些结果之后，消费者和卫生政策的制定者可以对采纳何种项目作出明智、科学的决策。但是，在设计卫生服务包时，也应充分考虑社会体制、公众偏好等社会因素。实证研究主要采用入户问卷调查方法。利用国家统计系统基点，由西安市、宝鸡市、广州市和珠海市城调队入户调查，样本代表性和问卷可信度较高。其中西安市、宝鸡市、广州市和珠海市分别收回有效问卷350份、150份、447份和150份。调查表明：四城市分别有25.21%、30.67%、45.94%和40%的家庭卫生支出率超过其承受能力，显示四城市现阶段医疗支出能力较弱，卫生支出负担较重。西安有51.7%的居民能承受目前的缴费水平，有41.1%的居民能承受但对生活有一定影响。宝鸡和广州有超过60%的居民能承受但对生活有一定影响，大约20%的居民能够承受目前的缴费水平。珠海有55.3%的居民能承受但对生活有一定影响，有32.7%的居民能承受目前的缴费水平。西安和宝鸡有大约90%的调查家庭同时购买了职工保险，分别有30.9%和26.7%的家庭购买了商业保险；广州和珠海的调查家庭同时购买职工保险的比例大大降低。四城市大部分居民家庭因为报销比例低而担心看病费用问题，其次是因为报销手续麻烦担心。西安、宝鸡和珠海大部分居民都认为医疗费用应占家庭收入的合理比例为1%-10%，其次是10%-20%；广州大部分居民认为医疗费用应占家庭收入的合理比例为5%-10%，其次是20%-30%。四城市大部分居民认为医保缴费应占家庭收入的合理比例是1%-5%，其次，西安、宝鸡和广州认为医保缴费占比应为1%以下，珠海认为应为5%-10%。仍有相当比例的居民认为应为10%-20%或更高。四城市大部分居民认为个人交费占比应为30%以下，有超过半数的居民认为个人交费占比应为10%以下，西安和宝鸡认为个人占比应为10%以下的居民比例高于广州和珠海，广州和珠海认为个人占比应为10%-30%的居民比例高于西安和宝鸡。宝鸡、广州和珠海最想增加的三项报销项目分别是急诊诊疗、药店买药和门诊取药，而西安最想增加的三项报销项目分别是药店买药、急诊诊疗和门诊诊疗。四城市居民在居民医保应该针对的主要大项方面比较一致，主要集中在常见病、多发病和大病，预防、保健和急诊方面反而比例较低。绝大部分居民认为应该增加口腔门诊治疗，其次为口腔保健和口腔住院治疗。其中，西安和宝鸡居民认为居民医保首先应该增加的口腔门诊项目是补牙和镶牙，而广州和珠海居民认为是定期口腔检查。西安和宝鸡居民家庭对居民医保改革的主要关注点是简化报销手续，其次才是降低共付比例，而广州和珠海更加关注降低共付比例，其次是降低起付线。为使城镇居民医保更好地满足群众需要，必须采用成本效果分析方法，，更加合理地设计卫生服务包，有效使用卫生资源。同时应：加大居民医保宣传力度，增强居民对医保的认识和了解。简化居民医保使用与报销手续，提高居民使用医保便利程度。增加多元筹资水平，满足不同人群需要，合理配置医疗资源，提升社区卫生服务水平。从而使城镇居民医保更加完善，为全民覆盖的医疗保障体制创造条件。
[Abstract]:The Central Committee of the party has identified the basic medical and health services for all as one of the important goals of building a well-off society in an all-round way, and building three basic medical and health systems covering urban and rural residents, including the basic medical insurance system for residents. The thesis aims to establish the theory and method of "basic health services package" for urban residents. This paper analyzes the cognition, demand, willingness to pay and payment ability of urban residents to medical insurance, and puts forward the suggestions for the design of medical insurance packages for urban residents in accordance with the national conditions of our country, and provides the basis for the establishment and improvement of the basic medical and health system and health system of the integrated urban and rural integration, prevention, medical treatment and health care in our country.
The main problem of the design of the basic health service package is how to improve the efficiency of the health service products, the need to analyze its cost and the available resources, and then adjust the contents of the included, until the content of the included projects and the level of available resources reach a balance.
Cost effectiveness analysis is a technology that makes the most effective use of limited resources. It analyzes and evaluate the resources used by health projects and the methods of obtaining health benefits. By using the cost effectiveness analysis, the decision-makers can choose from these projects. Although the cost effectiveness analysis does not tell us what kind of health clothing should be engaged in our society. But it provides a framework for information about the effectiveness and efficiency of health projects. After these results, consumers and health policy makers can make wise and scientific decisions on what kind of projects to adopt. However, social systems, public preferences, and other social factors should be taken into account in the design of health services.
The empirical study mainly adopts the household questionnaire survey method. Using the national statistical system base point, the survey of Xi'an, Baoji, Guangzhou and Zhuhai cities, the sample representation and the reliability of the questionnaire are high. Among them, Xi'an, Baoji, Guangzhou and Zhuhai have collected 350 valid questionnaires, 150, 447 and 150 respectively.
The survey showed that 25.21%, 30.67%, 45.94% and 40% of the four cities have more household health expenditure than their capacity, showing that four cities are weak in medical expenditure and the burden of health expenditure is heavy. 51.7% of the residents in Xi'an can bear the current level of payment, 41.1% of the residents can bear but have a certain impact on life. In the state, more than 60% of the residents can bear a certain impact on life, about 20% of the residents can bear the current level of payment. 55.3% of the residents in Zhuhai can bear but have a certain impact on their lives, and 32.7% of the residents can bear the current level of payment. In Xi'an and Baoji, about 90% of the survey families have also purchased employee insurance, respectively. 30.9% and 26.7% of households bought commercial insurance, while the proportion of employees surveyed in Guangzhou and Zhuhai greatly reduced their insurance coverage.
The majority of the residents in four cities are worried about the cost of seeing a doctor because of the low reimbursement rate. The second is because of the trouble of reimbursement. Most residents in Xi'an, Baoji and Zhuhai believe that the reasonable proportion of medical expenses should be 1%-10%, followed by 10%-20%; the majority of Guangzhou residents think that medical expenses should account for household income. The reasonable proportion is 5%-10%, followed by the majority of the residents in the 20%-30%. four city that the reasonable proportion of medical insurance contribution to the family income is 1%-5%. Secondly, Xi'an, Baoji and Guangzhou believe that the medical insurance contribution ratio should be less than 1%. Zhuhai believes that a considerable proportion of the residents of the 5%-10%. should be 10%-20% or higher. Four city residents recognize the majority of the residents. The proportion of individual payment should be less than 30%, and more than half of the residents think that the proportion of individual payment should be less than 10%. Xi'an and Baoji believe that the proportion of individuals who should be under 10% is higher than Guangzhou and Zhuhai, and Guangzhou and Zhuhai think that the proportion of individuals who should be 10%-30% is higher than that of Xi'an and Baoji.
Baoji, Guangzhou and Zhuhai are most likely to increase the three items of reimbursement, namely, emergency treatment, drugstore buying medicine and out-patient medicine, while Xi'an's most desirable three items of reimbursement are drugstores, emergency treatment and outpatient clinics. Four urban residents are more consistent in the major aspects of the residents' medical insurance, mainly in common diseases. The proportion of multiple diseases and major diseases, prevention, health care and emergency treatment is low. Most residents believe that oral outpatient treatment should be increased, followed by oral health care and oral inpatient treatment. Among them, residents in Xi'an and Baoji believe that the first oral outpatient items that residents should increase first are dental and dental inlay, while residents in Guangzhou and Zhuhai believe that The main concern for residents' health care reform in Xi'an and Baoji is to simplify reimbursement procedures, followed by reducing the proportion of CO payment, while Guangzhou and Zhuhai pay more attention to reducing the proportion of CO payment, followed by reducing the starting line.
In order to make the medical insurance of urban residents better to meet the needs of the masses, it is necessary to adopt the method of cost-effectiveness analysis, to design health-care packages more reasonably and to use health resources effectively. At the same time, we should increase the publicity of medical insurance, strengthen the residents' understanding and understanding of medical insurance, simplify the procedures for the use and reimbursement of residents' medical insurance, and improve the medical insurance for the residents. It is convenient to increase the level of multiple fund-raising, meet the needs of different populations, rationally deploy medical resources and improve the level of community health services, thus making the medical insurance of urban residents more perfect and creating conditions for the medical security system covered by the people.
【学位授予单位】：第四军医大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：F842.684

【参考文献】