医院内部医疗保险混合支付方式的实施探讨
发布时间：2018-09-15 05:39
【摘要】：目的通过比较江苏省某三级甲等综合性医院内部骨科和普外科医保住院患者按混合支付方式付费与传统按项目付费支付的实施效果，分析不同支付方式下医保患者医疗费用、医疗质量、服务效率、病人满意度等指标的变化和产生变化的原因，以期发现实施混合支付方式过程中需要改进的问题，为提高医疗质量、降低医疗费用、促进卫生资源的合理配置等提供依据。 材料与方法本研究选择2011年7月1日-2012年6月30日期间骨科实施按混合支付方式付费的医保住院病人500例为实验组，实施传统按项目付费支付的584例为对照组；普外科实施按混合支付方式付费的医保住院病人1281例为实验组，实施按项目付费支付的1123例为对照组。采用回顾性分析的方法，借助医院信息系统收集相关病人的住院信息，对支付方式的实施效果进行评价。效果评价指标涉及工作效率、经济效率和绩效评价等方面，对收集的数据进行统计学分析。 结果骨科和普外科实验组和对照组医保患者在性别、年龄和入院情况等方面差异无统计学意义（P0.05）。两个科实验组相对于对照组住院总费用、药品费用、材料费、床位费均下降，差异有统计学意义（P0.05）；治疗费、护理费和治愈好转率组间比较变化不大，差异无统计学意义（P0.05）；实验组病人满意度均高于对照组，差异有统计学意义（P0.05）。骨科实验组检查费低于对照组，差异有统计学意义（P0.05），普外科两组间检查费持平，差异无统计学意义（P0.05）。 结论医疗保险支付方式改革作为新医改的重要内容，是医疗保险过程中涉及各方经济利益最直接、最敏感的环节，对医疗服务的监控和抑制过度医疗有着举足轻重的作用。医院内部混合支付方式的实施能够引导医护人员规范诊疗行为，在保证医疗质量的前提下降低医疗费用，减轻患者负担，减少不必要的卫生资源消耗，使住院费用构成趋于合理化。
[Abstract]:Objective to compare the effect of medical expenses of medical insurance patients in general hospital of Grade 3A in Jiangsu Province by using mixed payment method and traditional payment by item payment method, and to analyze the medical cost of medical insurance patients under different payment methods. The changes of medical quality, service efficiency, patient satisfaction and the causes of the changes, in order to find out the problems that need to be improved in the process of implementing the mixed payment mode, in order to improve the quality of medical treatment and reduce the medical cost, To promote the rational allocation of health resources. Materials and methods from July 1, 2011 to June 30, 2012, 500 patients in orthopedic department were selected as experimental group and 584 patients as control group. In general surgery, 1281 medical inpatients paid for medical insurance were treated as experimental group and 1123 patients as control group. By means of retrospective analysis, the hospital information system was used to collect the inpatient information, and the effect of payment was evaluated. The data collected are statistically analyzed in the aspects of work efficiency, economic efficiency and performance evaluation. Results there was no significant difference in sex, age and admission between orthopaedic and general surgery groups and control group (P0.05). Compared with the control group, the total cost of hospitalization, drug cost, material cost, bed fee of the two experimental groups decreased significantly (P0.05), while the treatment cost, nursing cost and cure rate of the two groups did not change significantly (P0.05). The patients' satisfaction in the experimental group was higher than that in the control group, the difference was statistically significant (P0.05). The examination fee of orthopedic experimental group was lower than that of control group, the difference was statistically significant (P0.05), the examination fee of general surgery group was equal, the difference was not statistically significant (P0.05). Conclusion as an important part of the new medical reform, the reform of medical insurance payment mode is the most direct and sensitive link involving the economic interests of all parties in the process of medical insurance. It plays an important role in the monitoring of medical services and the suppression of excessive medical treatment. The implementation of the mixed payment method in hospital can lead the medical staff to standardize the diagnosis and treatment behavior, reduce the medical expenses, reduce the burden of the patients, and reduce the unnecessary consumption of health resources under the premise of ensuring the quality of medical treatment. Rationalize the composition of hospital expenses.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R197.3;F842.684
本文编号：2243937
[Abstract]:Objective to compare the effect of medical expenses of medical insurance patients in general hospital of Grade 3A in Jiangsu Province by using mixed payment method and traditional payment by item payment method, and to analyze the medical cost of medical insurance patients under different payment methods. The changes of medical quality, service efficiency, patient satisfaction and the causes of the changes, in order to find out the problems that need to be improved in the process of implementing the mixed payment mode, in order to improve the quality of medical treatment and reduce the medical cost, To promote the rational allocation of health resources. Materials and methods from July 1, 2011 to June 30, 2012, 500 patients in orthopedic department were selected as experimental group and 584 patients as control group. In general surgery, 1281 medical inpatients paid for medical insurance were treated as experimental group and 1123 patients as control group. By means of retrospective analysis, the hospital information system was used to collect the inpatient information, and the effect of payment was evaluated. The data collected are statistically analyzed in the aspects of work efficiency, economic efficiency and performance evaluation. Results there was no significant difference in sex, age and admission between orthopaedic and general surgery groups and control group (P0.05). Compared with the control group, the total cost of hospitalization, drug cost, material cost, bed fee of the two experimental groups decreased significantly (P0.05), while the treatment cost, nursing cost and cure rate of the two groups did not change significantly (P0.05). The patients' satisfaction in the experimental group was higher than that in the control group, the difference was statistically significant (P0.05). The examination fee of orthopedic experimental group was lower than that of control group, the difference was statistically significant (P0.05), the examination fee of general surgery group was equal, the difference was not statistically significant (P0.05). Conclusion as an important part of the new medical reform, the reform of medical insurance payment mode is the most direct and sensitive link involving the economic interests of all parties in the process of medical insurance. It plays an important role in the monitoring of medical services and the suppression of excessive medical treatment. The implementation of the mixed payment method in hospital can lead the medical staff to standardize the diagnosis and treatment behavior, reduce the medical expenses, reduce the burden of the patients, and reduce the unnecessary consumption of health resources under the premise of ensuring the quality of medical treatment. Rationalize the composition of hospital expenses.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R197.3;F842.684
【共引文献】
相关硕士学位论文 前1条
1 王申娟;新农村合作医疗的现状、问题及对策研究[D];山西师范大学;2012年
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