医疗保险支付方式改革对我国公立医院效率的影响研究

发布时间：2018-10-16 15:36

【摘要】：公立医院是我国医院的主体,肩负着保障人民健康的重要责任,公立医院的改革将使其主体作用得到更好的发挥。而支付方式改革通过建立新型补偿机制影响医疗服务行为成为公立医院改革的重心之一。支付方式改革能否通过建立有效的约束和激励机制改善医疗服务、提高医疗质量,并使公立医院摆脱传统低效的运营模式,在回归公益性的同时又高效配置医疗资源、提高医院效率,保障各方利益得到落实,实现公立医院的持续经营和稳健发展,这些都是医改深化面临的重要课题。因此,支付方式改革对我国公立医院效率的影响研究具有重要的理论和现实指导意义。本文首先回顾了医疗保险支付方式和医院效率的相关理论文献,然后分别从积极和消极方面分析我国支付方式改革对公立医院效率影响的现状,接着从理论模型分析到实证分析的顺序,收集整理我国卫生年鉴的统计数据进行定量分析,得出医院效率增减变动的规律以及支付方式改革对公立医院效率具有正向作用。论文采用数据包络模型和回归模型分析支付方式改革对我国公立医院技术效率的影响,采用随机前沿模型分析支付方式改革对我国公立医院成本效率的影响,并依据实证结果详细剖析了支付方式改革对我国公立医院效率正向作用的影响机制,最后在此基础上提出相应的对策建议,这对于我国公立医院改革的进一步深化具有一定的借鉴和参考价值。本文通过理论分析和实证检验的相互验证,得出了如下结论：支付方式改革对我国公立医院效率总体上具有积极影响。实证结果表明随着支付方式改革的进行,医院的效率总体呈上升趋势,特别是成本效率上升显著,技术效率总体上也呈上升趋势,只是在支付方式改革一两年后技术效率和成本效率均出现了短暂的回落,但随后继续上升,此外在卫生经济政策改革中支付方式改革对医院效率的积极影响最为显著。本文认为支付方式改革对医院效率的提升需从市场竞争机制、激励机制、管理机制以及综合评价机制等方面来实现。
[Abstract]:Public hospitals are the main body of our hospital and have the important responsibility to guarantee the health of the people. The reform of public hospitals will play a better role in the role of public hospitals. The reform of payment mode influences the behavior of medical service through the establishment of a new compensation mechanism and becomes one of the center of gravity of public hospital reform. The reform of payment mode can improve the medical service by establishing effective restriction and incentive mechanism, improve the quality of medical treatment, and make public hospital get rid of the traditional inefficient operation mode, and meanwhile efficiently allocate medical resources while returning to public welfare, improve the efficiency of hospital, To guarantee the realization of the interests of the parties and realize the continuous operation and steady development of public hospitals, these are the important tasks facing the deepening of medical reform. Therefore, the reform of payment method has an important theoretical and practical guiding significance to the research of the efficiency of public hospitals in our country. This paper firstly reviews the relevant theoretical documents of medical insurance payment mode and hospital efficiency, and then analyzes the present situation of the effect of payment mode reform on the efficiency of public hospitals from the positive and negative aspects, then analyzes the order of empirical analysis from the theoretical model. We collect and sort out the statistical data of health yearbooks in our country to carry out quantitative analysis, to get the law of increase and decrease of hospital efficiency and the reform of payment mode have positive effect on the efficiency of public hospitals. The paper adopts the data envelopment model and regression model to analyze the influence of payment mode reform on the technical efficiency of public hospitals in China, and adopts the random frontier model to analyze the influence of the reform on the cost efficiency of public hospitals in China. Based on the empirical results, this paper analyzes the influence mechanism of the reform of payment methods on the efficiency of public hospitals in our country, and finally puts forward corresponding countermeasures, which can be used for reference and reference for the further deepening of public hospital reform in our country. Through the mutual verification of theoretical analysis and empirical test, this paper concludes that the reform of payment method has a positive effect on the efficiency of public hospitals in our country. The empirical results show that with the reform of the payment mode, the efficiency of the hospital is generally on the rise, especially the cost efficiency rises obviously, and the technical efficiency is generally on the rise. However, it continued to rise and, in addition, the positive impact of mode reform on hospital efficiency in health and economic policy reform was the most significant. This paper holds that the reform of payment mode should be realized from market competition mechanism, incentive mechanism, management mechanism and comprehensive evaluation mechanism.
【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R197.1;F842.684

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