乐清市“新农合”医疗费用控制研究

发布时间：2018-11-03 11:12

【摘要】：自“新农合”在乐清市实行以来,参合农民受益面不断扩大,他们在享受“新农合”住院和报销制度的同时,“新农合”费用支出正逐年呈现上升趋势,遏制医疗费用的不合理增长成为“新农合”管理的重中之重。本文通过选择乐清市某三乙医院2013年1月1日-2013年12月31日期间入住的参加农村合作医疗病人为样本,采用SPSS软件,对各项费用进行分析,描述医疗费用控制的现状,测算和分析乐清市“新农合”费用控制的初步效果。在此基础上,提出乐清市“新农合”费用控制中存在的问题及成因。在借鉴国外及省外医疗费用控制特点的基础上,对当前乐清市新型农村合作医疗在其运行过程中的实施情况、影响因素、管理模式和监督运行机制等方面进行整理和分析。最后,分别从政府管理角度、医院角度和住院病人角度提出控制“新农合”费用的有效策略和措施。政府管理角度的对策有：多方位的定点医疗机构监管机制的建立；明确筹资方式是突破筹资问题的有效手段；鼓励发展城乡医疗保险一体化建设和引入三方保险机制。医院角度的对策有：加强医疗质量的管理,提高医疗服务水；推行综合质量双向考核机制；实行“新农保”药品的进价与售价无差价销售。住院病人角度的对策有：参合方认真学习和掌握“新农合”保障机制的相关内容和采取合适的医疗服务组合降低医疗费用支出。
[Abstract]:Since the implementation of "New Rural Cooperation" in Yueqing City, the benefits of participating farmers have been continuously expanded. While they enjoy the "New Rural Cooperation" hospitalization and reimbursement system, the expenses of "new rural cooperative cooperation" are showing an upward trend year by year. Curbing the unreasonable growth of medical expenses has become the top priority in the management of NCMS. In this paper, by selecting the rural cooperative medical care patients admitted from January 1, 2013 to December 31, 2013 in a third B Hospital in Yueqing City as samples, using SPSS software, the paper analyzes the various expenses and describes the current situation of medical cost control. Calculate and analyze the primary effect of cost control in Yueqing "New Rural Cooperation". On this basis, the paper puts forward the problems and causes in the cost control of Yueqing New Rural Cooperation. On the basis of drawing lessons from the characteristics of medical expenses control abroad and outside the province, this paper analyzes the implementation of the new rural cooperative medical system in Yueqing City in the process of its operation, the influencing factors, the management model and the supervision and operation mechanism, and so on. Finally, from the angle of government management, hospital and inpatient, the paper puts forward effective strategies and measures to control the cost of NCMS. The countermeasures from the angle of government management are as follows: the establishment of the supervision mechanism of multi-directional fixed-point medical institutions; the clear way of raising funds is an effective means to break through the problem of financing; the encouragement of the development of the integration of urban and rural medical insurance and the introduction of tripartite insurance mechanism. The countermeasures from the hospital point of view are as follows: strengthening the management of medical quality, improving medical service water, carrying out a comprehensive quality assessment mechanism, and carrying out the "New Rural Insurance" drug price and selling price without difference. The countermeasures of inpatients' angle are as follows: the participating parties study and master the relevant contents of the "New Rural Cooperation" security mechanism and adopt the appropriate combination of medical services to reduce the medical expenses.
【学位授予单位】：福建农林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684;F323.89;R197.1

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