上海市医疗保险支付制度研究

发布时间：2018-12-15 04:58

【摘要】：随着我国社会经济的发展,卫生保健事业取得了很大的进步,同时,医疗费用的上涨也成为了影响民生保障的一个问题,怎样控制医疗费用的不合理增长成为我国亟待解决的重要问题。本文将医保支付制度改革作为研究内容,以上海市为例具体研究。本文主要采取文献研究和定性分析、定量分析结合的方法。对上海市医疗保险支付制度进行了较为系统和深入的研究。理论分析部分主要对5种医保支付方式的概念和利弊进行了分析和对比,考虑到上海市的医保支付制度以总额预付制为主线,特地对总额预付制背后的经济学理论、国际经验、我国实施情况作了详细分析。现状分析部分先对上海市近年来的医保支付制度改革历程作了回顾,在了解了来龙去脉之后总结出上海市在医保支付制度改革中的特色,并对当前医保支付制度的构成以及工作中的难点进行了分析。实证分析部分,本文结合从统计年鉴中搜集的数据和大量的参考文献,从3个角度进行实证研究,首先从收入、支出、结余三个角度分析医保基金的运营状况,得出目前医保基金运营状况良好的结论,接着通过一家三级医院的数据剖析医保支付制度改革对于医院的医疗行为的影响,得出总额预付制改革以来医院的医疗费用控制情况和费用结构优化情况均得到好转。最后构建了上海市医疗费用的实证模型,通过EVIEWS 7.0软件对数据进行处理,得到了影响上海市医疗费用因素的模型,其中经济增长和人口老龄化与医疗费用保持同向变化,而上海市2002年以来的医保支付制度改革也被实证检验证明取得了显著的作用。通过以上分析,本文得出结论,上海市医保支付制度的改革取得了一定成效。不过背后存在的一些问题我们也不能忽视,包括医保预算费用的测算还有改进空间,对于医院分解医保指标、推诿病人等现象还需要更多的监控措施。
[Abstract]:With the development of social economy in our country, great progress has been made in the cause of health care. At the same time, the rise in medical expenses has also become a problem affecting the livelihood of the people. How to control the unreasonable growth of medical expenses has become an important problem to be solved. This paper takes the reform of Medicare payment system as the research content, taking Shanghai as an example. This article mainly adopts the literature research and the qualitative analysis, the quantitative analysis unifies the method. The system of medical insurance payment in Shanghai is studied systematically and deeply. The theoretical analysis part mainly analyzes and compares the concepts, advantages and disadvantages of five kinds of medical insurance payment methods, considering that Shanghai's medical insurance payment system takes the total prepaid system as the main line, especially the economic theory and international experience behind the total prepaid system. The implementation situation of our country is analyzed in detail. In the part of current situation analysis, the author reviews the history of medical insurance payment system reform in Shanghai in recent years, and summarizes the characteristics of Shanghai medical insurance payment system reform. At the same time, the composition of the current medical insurance payment system and the difficulties in the work are analyzed. In the part of empirical analysis, this paper combines the data collected from the statistical yearbook and a large number of references to carry out empirical research from three angles. Firstly, it analyzes the operating status of the medical insurance fund from the three angles of income, expenditure and balance. Draw the conclusion that the current health insurance fund is in good condition, and then analyze the impact of the reform of the medical insurance payment system on the medical behavior of the hospital through the data of a tertiary hospital. It is concluded that the control of medical expenses and the optimization of cost structure have been improved since the reform of total advance system. Finally, the empirical model of Shanghai medical cost is constructed, and the data are processed by EVIEWS 7.0 software, and the model of influencing factors of Shanghai medical cost is obtained, in which economic growth and population aging keep changing in the same direction with medical cost. The reform of health insurance payment system in Shanghai since 2002 has been proved to be significant by empirical test. Through the above analysis, this paper draws a conclusion that the reform of health insurance payment system in Shanghai has achieved certain results. However, there are some problems that we can not ignore, including the calculation of health care budget costs, there is room for improvement, for hospitals to decompose health insurance indicators, prevarication of patients and other phenomena still need more monitoring measures.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684

【相似文献】