旬邑县新型农村合作医疗住院费用总额预付制研究

发布时间：2018-10-18 18:40

【摘要】：新型农村合作医疗作为国家医疗卫生事业发展的一项重大举措,已经走过近十个年头。在这十年里,农村的医疗保障事业发生了从无至有质的转变。但医疗费用过快增长使农民的补偿收益大打折扣。虽然新型农村合作医疗的补偿比例在逐年提高,但农民看病贵的问题并没有得到实际缓解,新农合每年给农民增加的补偿大部分被医疗费用的上涨所抵消,探究造成医疗费用上涨的原因,传统按医疗服务项目付费方式存在种种缺陷,使得各地已经开始探索各种医疗支付方式的改革,支付方式由后付制向预付制转变、多元化的付费选择是改革的方向。陕西省旬邑县于2010年3月开始新农合支付方式改革试点,是全国较早的对于住院统筹实行总额预付制的试点县。本文就是在对旬邑县新型农村合作医疗住院统筹总额预付制试点运行情况了解的基础上,通过实地调研和专家访谈,获得第一手的运行数据和材料,试图求证总额预付制在实践过程中取得的成效和存在的问题,为新农合支付方式进一步改革提供实证依据。本文通过对旬邑县住院费用总额预付制改革运行情况进行分析与讨论,重点对比改革前后总额预付制对医疗费用控制、新农合经办机构、定点医疗机构、参合农民产生的影响,并发现问题。针对问题,分析产生问题的根源,提出总额测算是关系总额预付制度运行效果的最重要因素,总额预付制的难点和核心在于科学合理的总额测算。探索有针对性的解决方法,并提出完善住院费用总额预付制的对策建议,即应加强医院服务的考核与管理、选择合适的测算方法并确保相关配套措施的协调调动。最后,总结并提炼出值得借鉴的经验、教训和需要进一步研究的问题,为实现总额预付制的规范化、科学化发展及支付方式的进一步改革提供实证依据,为西部其它地区相关政策的制定提供参考和借鉴,以期推广。
[Abstract]:As an important measure in the development of national medical and health care, the new rural cooperative medical system has gone through nearly ten years. In this decade, rural health care has undergone a qualitative transformation from nil. However, the rapid growth of medical costs has greatly reduced the compensation benefits of farmers. Although the proportion of compensation for the new rural cooperative medical care is increasing year by year, the problem of farmers' expensive medical treatment has not actually been alleviated. The annual increase in compensation provided by NCMS to farmers is largely offset by the increase in medical costs. To explore the causes of the rise in medical expenses, there are various defects in the traditional method of paying for medical services according to the items of medical services, which has led to the exploration of the reform of various medical payment methods in various places, and the change of payment methods from the back payment system to the prepaid system. Diversification of payment options is the direction of reform. Xunyi County of Shaanxi Province began the pilot reform of the new rural cooperative payment system in March 2010. This paper is based on the understanding of the pilot operation of the new rural cooperative medical system in Xunyi County, through field research and expert interviews, to obtain first-hand operation data and materials. This paper attempts to prove the effectiveness and problems of the total advance payment system in the process of practice, and provide an empirical basis for the further reform of the new rural cooperative payment system. Through the analysis and discussion of the operation of the reform of the total advance system of hospital expenses in Xunyi County, this paper focuses on the comparison of the effects of the total advance system on the control of medical expenses, the new rural cooperative agencies, the designated medical institutions, and the participating farmers before and after the reform. And discover the problem. In view of the problem, this paper analyzes the root cause of the problem, and puts forward that the calculation of total amount is the most important factor in the operation effect of the total advance payment system. The difficulty and core of the total advance payment system lies in the scientific and reasonable calculation of the total amount. This paper explores the relevant solutions, and puts forward some countermeasures and suggestions to improve the system of total advance payment of hospital expenses, that is, to strengthen the examination and management of hospital services, to select the appropriate calculation methods and to ensure the coordinated mobilization of relevant supporting measures. Finally, it summarizes and abstracts the experiences, lessons and problems that need further study, which provides the empirical basis for the standardization, scientific development and the further reform of the payment method. To provide reference and reference for the formulation of relevant policies in other regions of the west, with a view to promoting.
【学位授予单位】：西北大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F323.89;R197.1;F842.684

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