县级定点医院结核病服务提供补偿策略研究

发布时间：2018-01-04 22:10

本文关键词：县级定点医院结核病服务提供补偿策略研究　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景2015年,我国有918万人患有肺结核,35万人死于肺结核,肺结核是我国重点防治的重大传染病之一。随着结核病防治策略和防治模式的转变,不同机构间的职责也随之调整,定点医院开始承担原来由疾病预防控制机构负责的一般性结核患者的免费筛查、登记报告、诊断治疗和健康教育等职责。在疾病预防控制机构负责一般性结核患者期间,国家以中央专项经费的方式补偿其提供的结核病服务。但是,职责调整后,并没有出台配套的定点医院提供结核病服务的补偿政策,而结核病的门诊治疗纳入基本医疗保障刚刚起步,如何与政府投入及其他社会救助资源相结合尚在探索阶段,这已经严重影响了结核病防治工作的有效开展,探讨定点医院结核病服务提供补偿策略显得尤为重要。研究目的本研究通过收集结核病定点医疗机构承担结核病诊疗服务的补偿现状以及职责调整前后医院运行和结核病防治工作质量的变化情况,探讨可能的影响因素,总结经验,提出定点医疗机构承担结核病免费诊疗服务的补偿策略。研究方法本研究按照经济发展水平在全国东中西部分别抽取山东、湖南、陕西三个省为样本省,根据结核病定点医院工作开展情况采用目的抽样方法在每个样本省抽了两个县(市、区)作为样本县,收集定点医院提供结核病服务的补偿现状,职责调整前后样本县定点医院的运行情况、结核患者登记和治疗效果变化情况;通过访谈了解定点医院模式存在的问题和困难,以及对定点医院模式的补偿建议。收集的定量资料用Microsoft Access 2007建立数据库,数据的统计分析用SPSS20.0完成。定性资料用Nvivo 10进行主题归纳分析。主要结果(1)多数地方政府对定点医院承担结核病服务投入以疾控原有的设备为主,对医院提供的部分结核病公共卫生服务缺乏补偿,部分地区结核病门诊服务还没有纳入医保门诊报销的范畴。(2)在不同补偿模式下,职责调整前后定点医院总收入均呈上升趋势,收入结构的变化不大。实行定点医院模式以后,所有补偿模式医院的医疗收入占总收入的比例一直94%以上,财政补助收入占总收入的比例都低于5%,提供公共卫生服务的收入少,结核科的收入占医院收入比例在0.81%-5.89%之间。(3)除了全面补偿模式的长沙,其他模式定点医院的结核科医务人员收入是医院员工平均收入的30%-90%,结核科室医务人员的绩效奖金收入占总收入的比例在50%-60%,结核病诊疗队伍的稳定性和可持续性受到影响。(4)在不同的补偿模式下,结核病的治愈率和治疗完成率基本都在85%以上,基本能够满足国家防治规划的要求。结核患者登记率除了补偿人员模式,其他模式下降了 21.4%-78.1%,下降幅度由大到小依次是补偿匮乏模式、补偿服务模式和全面补偿模式。结论与建议目前政府对定点医院提供结核病服务的投入不足,对定点医院提供的结核病公共卫生服务缺乏补偿,医院的收入结构没有发生改变,结核科的业务量在增加,结核科医务人员收入普遍低于医院的平均水平;在投入和补偿相对全面,但是缺乏监督和考核的情况下,结核病登记管理工作质量效果并不理想;在补偿人员模式下,政府或者医院对结核病从业人员工资的政策倾斜,将工作数量与质量与补偿挂钩的情况下,结核病登记管理工作质量最好,在补偿匮乏模式下,结核病登记管理工作质量出现严重下滑。因此提出以下建议:(1)将结核病门诊服务纳入医保门诊报销的范畴,制定符合结核病疾病特点的医保补偿政策。(2)增加和完善定点医院承担结核病公共卫生服务的补偿政策。(3)建立有效的人员激励机制,保障结核病医务人员的工资待遇,稳定结核病防治人才队伍。(4)建立定点医院结核病服务提供的考核监督机制,确定监管主体,明确各方职责,提高结核病患者管理登记的工作质量。
[Abstract]:On the background of 2015, China has 9 million 180 thousand people suffering from tuberculosis, 350 thousand people died of tuberculosis, tuberculosis is one of the major infectious disease prevention in China. With the change of TB control strategies and control modes, different inter agency responsibilities are adjusted, free screening, hospitals began to take the original charge by the Centers for Disease Control and prevention the general tuberculosis registration report, diagnosis, treatment and health education and other duties. In the disease prevention and control institutions responsible for general tuberculosis patients during the national special funds to the central compensation provided by TB services. However, duty adjustment, and no designated hospitals providing TB services supporting the introduction of compensation policy, and outpatient treatment of tuberculosis included in the basic medical insurance has just started, and how government investment and other social assistance resources combination is still in the exploratory stage, this Have a serious impact on the effective development of TB prevention and control work, to explore the hospital tuberculosis services compensation strategy is particularly important. The changes of hospital operation and tuberculosis prevention and control work quality the research purpose of this study bear compensation situation of tuberculosis diagnosis and treatment services through the collection of TB designated medical institutions and duties before the adjustment, to explore the factors that may affect the experience. A compensation scheme is proposed, the designated medical institutions for free TB treatment services. The research methods in accordance with the level of economic development in the East and west respectively from Shandong, Hunan, three provinces of Shaanxi Province as a sample, according to the work of TB hospitals carried out by objective sampling method in each sample, pumping two counties (city, district) as the sample County, compensation collection in designated hospitals provide TB service, duty adjustment after The operation of county hospitals, changes of tuberculosis patients and treatment effect; understanding the existing model of designated hospital problems and difficulties through interviews, as well as the model of designated hospital compensation recommendations. The quantitative data collected by the Microsoft Access 2007 database, the statistical analysis of the data by SPSS20.0. Qualitative data were analyzed in 10 subjects Nvivo. The main results (1) most of the local government to bear TB services in the original equipment to control investment. Based on the designated hospital, part of the public health service of tuberculosis hospital provides the lack of compensation, some areas of tuberculosis outpatient service is not included in the Medicare outpatient reimbursement category. (2) in different compensation mode, duty adjustment the total income of designated hospitals increased, little change in the income structure. After the implementation of the designated hospitals, the hospital all compensation mode The medical income proportion of the total income has more than 94% financial subsidies, the proportion of total revenue of less than 5%, the provision of public health services and less income, tuberculosis Department income of hospital income ratio between 0.81%-5.89%. (3) in addition to the full compensation mode Changsha, other modes of Hospital Department of tuberculosis medical staff income is the average income of hospital staff 30%-90%, tuberculosis department medical staff performance bonus income to total revenue in the proportion of 50%-60%, the stability and sustainability of TB treatment team affected. (4) in compensation mode under different TB cure rate and completion rate of over 85% in the basic, basic can meet the national prevention and control planning requirements. Tuberculosis registration rate in addition to compensation mode, other modes decreased by 21.4%-78.1%, decreased from high to low is the lack of compensation mode, compensation service Model and comprehensive compensation model. The conclusion and suggestion the government provide services for TB designated hospitals is insufficient, provide to designated hospitals for TB public health services lack of compensation, the income structure of the hospital did not change, the volume of business department of tuberculosis has increased, the average level of TB medical personnel income is generally lower than the investment in Hospital; and the compensation is relatively comprehensive, but the lack of supervision and examination of the case, tuberculosis registration and administration of quality is not satisfactory; in personnel compensation mode, government or hospital on TB staff wages policy, work quantity and quality and compensation under the condition of the hook, the TB registration management work in the best quality, lack of compensation under the mode of tuberculosis management quality serious decline. Therefore put forward the following suggestions: (1) the tuberculosis outpatient services included in health insurance The category of outpatient reimbursement policy, in line with the characteristics of TB disease. (2) the increase of insurance compensation and compensation policy take TB hospitals improve public health services. (3) the establishment of an effective incentive mechanism to protect TB personnel, medical personnel wages, stability of TB prevention and control personnel. (4) the establishment of TB services the hospital evaluation and supervision mechanism to determine the regulatory body, clear responsibilities of the parties, to improve the management of TB patients registered in the quality of work.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R52;R197.1

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