拉萨市医疗保险付费方式研究
发布时间：2018-10-15 17:25
【摘要】：目前，我国的医疗卫生和医疗保障领域存在许多问题，“看病贵、看病难”的问题是这诸多问题中的一个突出问题，严重影响到人民群众医疗保障需求的满足。为解决这一问题，在医疗卫生领域进行了多项改革，而对基本医疗保险付费方式的改革是诸多改革中重点。通过付费方式和模式的改革，可以更好的管控医疗服务机构的各种行为（重点是医疗服务行为），进而达到控制医疗服务成本，抑制医疗费用过分支出，最终达到缓解医保经费支付的压力，化解支付风险的目的。通过各项改革，将人民群众在看病就医时的经济损失降到最低。如今世界上存在六种主要的医疗保险付费方式，即按服务项目付费、按病种付费、总额预付、按人头付费、按单元付费和定额结算。对每种付费方式进行比较分析，都能发现这一付费方式存在一定的优势和一定的使用范围，同时，每一种付费方式也存在不足。在实践中，基本医疗保险管理部门会根据实际情况需要，组合使用不同付费方式，形成复合式的医疗保险付费模式。目前，在中国，覆盖全国所有公民的基本医疗保险制度已基本建立，主要包括三项制度：即针对广大农村居民的新农合制度、针对城镇没有就业人口的城镇居民医保制度和针对城镇就业人口的城镇职 工医保制度，三项制度基本上已经能够覆盖我国所有的人群。不过，在统一的制度体系下，具体的运行方式会有所不同，体现在医疗保险付费方式上，就是不同地区所具体使用的付费方式并不一模一样。近年来，多个地方进行了医疗保障制度和医疗卫生体制的改革，在这些改革中，付费方式的改革一直都是重要内容之一。在一定程度上，各个地方现行的基本医疗保险付费方式都有一定的效果，对于费用上涨的控制、患者负担的减轻都能起到一定作用，但也有控制医疗费用与满足医疗需求之间存在矛盾、医疗保险经办机构管理成本偏高、落实定点医疗服务机构内部管理不足等问题仍然需要进一步解决。 从总体上看，拉萨市基本医疗保险制度中，依然沿用按服务项目付费这种比较传统的付费方式，是一种比较简单而且单一的付费方式。这种付费方式的使用在短期内没有影响到整个基本医疗保险体制的运行，但从长远来看，还需要调整和完善。通过综合分析国内外现行医疗保险付费方式、比较分析我国和拉萨市现行付费方式和模式，本文提出在拉萨市，有必要对现行的付费方式进行改革和完善，在改革中，首先要吸取其他地方医疗保险付费方式改革的成功经验，其次要加快城乡基本医疗保险制度的统一和整合，三是要积极探索实行有效机制，，实现定点医疗服务机构的分级分类管理，最后要探索有效手段，建立健全专家谈判协商的机制。希望在西藏自治区的基本医疗保障制度的改革中，这些建议可以发挥一些积极的影响。
[Abstract]:At present, there are many problems in the field of health care and medical security in our country. The problem of "seeing a doctor is expensive but difficult to see a doctor" is one of the outstanding problems, which seriously affects the satisfaction of the people's medical security needs. In order to solve this problem, many reforms have been carried out in the field of medical and health care, and the reform of the basic medical insurance payment method is the focus of many reforms. Through the reform of payment mode and mode, we can better control all kinds of behavior of medical service organization (focus on medical service behavior), and then control the cost of medical service and restrain the excessive expenditure of medical cost. Finally, the purpose of relieving the pressure of medical insurance payment and reducing the risk of payment is achieved. Through various reforms, the economic loss of the masses when seeking medical treatment was reduced to the minimum. Nowadays, there are six main ways to pay for medical insurance in the world, that is, by service item, by disease, by total advance, by head, by unit and by quota. Through the comparative analysis of each payment method, we can find that there are certain advantages and certain scope of use of this payment method, and at the same time, each payment method also has some shortcomings. In practice, the basic medical insurance management department will combine different payment methods according to the actual situation to form a compound medical insurance payment mode. At present, in China, a basic medical insurance system covering all citizens of the country has basically been established, which mainly includes three systems: a new rural cooperative system for the majority of rural residents. For the medical insurance system of urban residents without employment in cities and towns and the occupational insurance system of urban workers in cities and towns, the three systems can basically cover all the people in our country. However, under the unified system, the specific mode of operation will be different, reflected in the medical insurance payment method, that is, different regions of the specific use of payment methods are not the same. In recent years, many places have carried on the medical security system and the health care system reform, in these reforms, the payment way reform has been one of the important contents. To a certain extent, the existing basic medical insurance payment methods in various localities have certain effects, which can play a certain role in controlling the increase in costs and reducing the burden on patients. However, there are also contradictions between controlling medical expenses and meeting medical needs. The management cost of medical insurance agencies is on the high side, and the internal management of designated medical service institutions needs to be further solved. Generally speaking, in the basic medical insurance system of Lhasa, it is a relatively simple and single way to pay by service items, which is a more traditional way of payment. The use of this payment method does not affect the operation of the whole basic medical insurance system in the short term, but in the long run, it still needs to be adjusted and improved. Based on the comprehensive analysis of the current medical insurance payment methods at home and abroad, and the comparative analysis of the current payment methods and models between China and Lhasa, this paper points out that it is necessary to reform and perfect the current payment methods in Lhasa, and in the course of the reform, First of all, we should absorb the successful experience of other localities in the reform of medical insurance payment methods; secondly, we should speed up the unification and integration of the basic medical insurance system in urban and rural areas; and third, we should actively explore and implement effective mechanisms. Finally, it is necessary to explore effective means to establish and perfect the mechanism of expert negotiation and consultation. It is hoped that these suggestions will play a positive role in the reform of the basic medical security system in Tibet Autonomous region.
【学位授予单位】：西藏大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684;R197.1
[Abstract]:At present, there are many problems in the field of health care and medical security in our country. The problem of "seeing a doctor is expensive but difficult to see a doctor" is one of the outstanding problems, which seriously affects the satisfaction of the people's medical security needs. In order to solve this problem, many reforms have been carried out in the field of medical and health care, and the reform of the basic medical insurance payment method is the focus of many reforms. Through the reform of payment mode and mode, we can better control all kinds of behavior of medical service organization (focus on medical service behavior), and then control the cost of medical service and restrain the excessive expenditure of medical cost. Finally, the purpose of relieving the pressure of medical insurance payment and reducing the risk of payment is achieved. Through various reforms, the economic loss of the masses when seeking medical treatment was reduced to the minimum. Nowadays, there are six main ways to pay for medical insurance in the world, that is, by service item, by disease, by total advance, by head, by unit and by quota. Through the comparative analysis of each payment method, we can find that there are certain advantages and certain scope of use of this payment method, and at the same time, each payment method also has some shortcomings. In practice, the basic medical insurance management department will combine different payment methods according to the actual situation to form a compound medical insurance payment mode. At present, in China, a basic medical insurance system covering all citizens of the country has basically been established, which mainly includes three systems: a new rural cooperative system for the majority of rural residents. For the medical insurance system of urban residents without employment in cities and towns and the occupational insurance system of urban workers in cities and towns, the three systems can basically cover all the people in our country. However, under the unified system, the specific mode of operation will be different, reflected in the medical insurance payment method, that is, different regions of the specific use of payment methods are not the same. In recent years, many places have carried on the medical security system and the health care system reform, in these reforms, the payment way reform has been one of the important contents. To a certain extent, the existing basic medical insurance payment methods in various localities have certain effects, which can play a certain role in controlling the increase in costs and reducing the burden on patients. However, there are also contradictions between controlling medical expenses and meeting medical needs. The management cost of medical insurance agencies is on the high side, and the internal management of designated medical service institutions needs to be further solved. Generally speaking, in the basic medical insurance system of Lhasa, it is a relatively simple and single way to pay by service items, which is a more traditional way of payment. The use of this payment method does not affect the operation of the whole basic medical insurance system in the short term, but in the long run, it still needs to be adjusted and improved. Based on the comprehensive analysis of the current medical insurance payment methods at home and abroad, and the comparative analysis of the current payment methods and models between China and Lhasa, this paper points out that it is necessary to reform and perfect the current payment methods in Lhasa, and in the course of the reform, First of all, we should absorb the successful experience of other localities in the reform of medical insurance payment methods; secondly, we should speed up the unification and integration of the basic medical insurance system in urban and rural areas; and third, we should actively explore and implement effective mechanisms. Finally, it is necessary to explore effective means to establish and perfect the mechanism of expert negotiation and consultation. It is hoped that these suggestions will play a positive role in the reform of the basic medical security system in Tibet Autonomous region.
【学位授予单位】：西藏大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684;R197.1
【参考文献】
相关期刊论文 前10条
1 陈燕凌;刘宏鸣;张琛;李书章;;国内外医疗费用支付方式的比较研究[J];重庆医学;2008年09期
2 邓燕云;郑洲;;西藏与四川新型农村合作医疗制度实践模式比较研究[J];中国藏学;2008年04期
3 梁春贤;;我国医疗保险费用支付方式问题的探讨[J];财政研究;2007年08期
4 朱玲;西藏农牧区基层医疗服务供给[J];湖南社会科学;2005年02期
5 李晓晖;刘启明;;社会医疗保险中混合式医疗费用支付方式的探索[J];河南大学学报(社会科学版);2011年03期
6 贾洪波;王s
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