长沙市社会医疗保险混合支付方式研究
发布时间：2018-12-29 09:24
【摘要】：医疗费用的过快增长一直是制约我国卫生事业发展的因素之一,为此,深化医药卫生体制改革是大势所趋,改革的内容涉及多个方面,其中,对于医疗保险支付方式的改革是当中的重点和难点。纵观改革大势,各地对医疗保险支付方式的改革呈现出多样化。长沙市自2000年建立城镇职工基本医疗保险制度以来,对于医疗保险支付方式的改革也在探索中前进,长沙市在医疗保险支付方式改革进程中取得了哪些成果?又存在哪些问题?如何突破现有的制度困境?这些问题都很值得研究,也具有一定的现实意义。本文就是以长沙市医疗保险支付方式改革作为切入点,具体探讨长沙市在医疗保险支付方式改革进程中取得的成效和存在的问题,在此基础上对长沙市支付方式未来的改革方向进行构建。 本文在对国内外文献进行深入研究的基础上,首先,对各种常见支付方式进行经济学分析,基于委托-代理理论提出预付制才是改革的正确方向；其次,基于对长沙市医疗保险事业发展的准确把握,具体分析长沙市医疗保险支付方式在改革进程中取得的成效和存在的问题；而后,通过借鉴国外典型国家和我国典型地区的医疗保险支付方式改革的经验,在此基础上,提出长沙市医疗保险混合支付方式的构建思路。研究的主要结论如下： 1.长沙市在医疗保险支付方式改革过程中,取得的成效包括：医疗保险统筹基金运行平稳,医疗费用个人负担的比例有所下降,医生负担病人情况逐步降低,同时采取按单病种付费之后,次均费用和住院天数均有所下降。 2.长沙市在医疗保险支付方式改革进程中,存在的问题包括：统筹基金支出的增长率高于收入增长率,单病种付费所占比例过小,在医疗费用中药品费用所占比重过高,同时基层医疗机构的作用未充分体现。 3.长沙市医疗保险混合支付方式的构建：推行总额预付,继续扩大按单病种付费,实行基本药物目录零差率销售制度三个方面。
[Abstract]:The excessive growth of medical expenses has always been one of the factors restricting the development of health care in China. Therefore, deepening the reform of the medical and health system is the trend of the times. The content of the reform involves many aspects, among which, The reform of medical insurance payment is the key and difficult point. Throughout the general trend of reform, all over the medical insurance payment mode of reform presents diversification. Since the establishment of the basic medical insurance system for urban workers in Changsha in 2000, the reform of the payment mode of medical insurance is also in the process of exploration. What achievements have been made in the reform of the medical insurance payment mode in Changsha? What are the problems? How to break through the existing system dilemma? These problems are very worthy of study, but also have certain practical significance. This paper, taking the reform of medical insurance payment mode in Changsha as the starting point, specifically discusses the achievements and existing problems in the process of medical insurance payment reform in Changsha. On the basis of this, the future reform direction of payment mode in Changsha is constructed. Based on the in-depth study of domestic and foreign literature, this paper first of all, the economic analysis of a variety of common payment methods, based on the principal-agent theory is the correct direction of the reform of the prepayment system; Secondly, based on the accurate understanding of the development of medical insurance in Changsha, the paper analyzes the effect and problems of the medical insurance payment in Changsha. Then, based on the experience of medical insurance payment reform in typical countries and regions of China, this paper puts forward the construction idea of mixed payment mode of medical insurance in Changsha. The main conclusions are as follows: 1. In the course of the reform of the medical insurance payment system in Changsha City, the results have included: the smooth operation of the medical insurance overall planning fund, the decrease in the proportion of individual burdens for medical expenses, and the gradual decrease in the burden on patients by doctors. At the same time, the average fee and the number of days in hospital decreased after the single-disease payment. 2. In the process of medical insurance payment reform in Changsha, the existing problems include: the growth rate of overall fund expenditure is higher than the income growth rate, the proportion of single-disease payment is too small, and the proportion of drug expenditure in medical expenses is too high. At the same time, the role of primary medical institutions is not fully reflected. 3. The construction of mixed payment method of medical insurance in Changsha city: carry out total advance, continue to expand the payment by single disease, and implement the zero difference sales system of essential drugs catalogue.
【学位授予单位】：湖南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684
本文编号：2394652
[Abstract]:The excessive growth of medical expenses has always been one of the factors restricting the development of health care in China. Therefore, deepening the reform of the medical and health system is the trend of the times. The content of the reform involves many aspects, among which, The reform of medical insurance payment is the key and difficult point. Throughout the general trend of reform, all over the medical insurance payment mode of reform presents diversification. Since the establishment of the basic medical insurance system for urban workers in Changsha in 2000, the reform of the payment mode of medical insurance is also in the process of exploration. What achievements have been made in the reform of the medical insurance payment mode in Changsha? What are the problems? How to break through the existing system dilemma? These problems are very worthy of study, but also have certain practical significance. This paper, taking the reform of medical insurance payment mode in Changsha as the starting point, specifically discusses the achievements and existing problems in the process of medical insurance payment reform in Changsha. On the basis of this, the future reform direction of payment mode in Changsha is constructed. Based on the in-depth study of domestic and foreign literature, this paper first of all, the economic analysis of a variety of common payment methods, based on the principal-agent theory is the correct direction of the reform of the prepayment system; Secondly, based on the accurate understanding of the development of medical insurance in Changsha, the paper analyzes the effect and problems of the medical insurance payment in Changsha. Then, based on the experience of medical insurance payment reform in typical countries and regions of China, this paper puts forward the construction idea of mixed payment mode of medical insurance in Changsha. The main conclusions are as follows: 1. In the course of the reform of the medical insurance payment system in Changsha City, the results have included: the smooth operation of the medical insurance overall planning fund, the decrease in the proportion of individual burdens for medical expenses, and the gradual decrease in the burden on patients by doctors. At the same time, the average fee and the number of days in hospital decreased after the single-disease payment. 2. In the process of medical insurance payment reform in Changsha, the existing problems include: the growth rate of overall fund expenditure is higher than the income growth rate, the proportion of single-disease payment is too small, and the proportion of drug expenditure in medical expenses is too high. At the same time, the role of primary medical institutions is not fully reflected. 3. The construction of mixed payment method of medical insurance in Changsha city: carry out total advance, continue to expand the payment by single disease, and implement the zero difference sales system of essential drugs catalogue.
【学位授予单位】：湖南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684
【参考文献】
相关期刊论文 前10条
1 刘君;何梦乔;;医疗保险混合支付方式研究[J];保险研究;2010年07期
2 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
3 韩俊江;胡丹;;创新医保支付方式化解“看病贵”探析——以长春市医疗保险支付方式改革为例[J];东北师大学报(哲学社会科学版);2012年02期
4 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
5 赵一夫,杨经福;浅析信息不对称导致的道德风险问题[J];经济师;2001年06期
6 崔怡莹;;城镇职工基本医疗保险三种付费方式的比较——以天津市为例[J];内蒙古科技与经济;2010年21期
7 赵颖旭;;美国医疗照顾制度的主要医疗服务支付方式介绍[J];中国全科医学;2012年28期
8 陈晖;刘宗龙;;世界各国医疗保险支付方式之比较分析[J];天津社会保险;2012年05期
9 董文勇;;德国社会医疗保险用药费用控制制度及其对中国的启示[J];环球法律评论;2006年02期
10 苏榕生;张仰龙;李进亮;;混合支付方式是新型农村合作医疗的合理选择[J];卫生经济研究;2006年08期
，本文编号：2394652
本文链接：https://www.wllwen.com/jingjilunwen/bxjjlw/2394652.html
