广东省城市公立医院医疗服务价格调整测算方案研究

发布时间：2018-06-07 05:45

本文选题：城市公立医院 + 医疗服务价格　；参考：《南方医科大学》2017年硕士论文

【摘要】：研究背景自2009年新医改启动以来,公立医院补偿机制改革、医疗服务价格形成机制改革已逐步成为医改的核心任务,国家先后出台若干文件,各地也在不断进行试点改革。2012年开始,我国加快推进公立医院医药价格改革。2016年7月,国家发改委等四部门联合印发《关于推进医疗服务价格改革意见的通知》(发改价格(2016]1431号)文件提出,我国将按照“总量控制、结构调整、有升有降、逐步到位”的要求,全面推进医疗服务价格改革,由此掀起新一轮医疗服务价格改革热潮。目前,全国部分省市如北京、上海、江苏、安徽等已走在医疗服务价格改革前列,广东省仅有深圳、中山、东莞、珠海开展试点工作。尽管广东省在深化医疗服务价格改革中取得积极成效,但医疗服务价格尚未理顺、管理方式仍需改进、价格行为有待进一步规范。因此,本研究全面梳理相关定价理论和定价方法,根据国家有关医疗服务价格改革文件精神要求,借鉴国外先进的做法及我国已进行医疗价格改革省市的经验,在对广东省驻穗省属、部属、军队医院近三年经济基础数据进行收集和分析的基础上,研究广东省城市公立医院医疗服务价格调整原则、调整范围、调整幅度,构建医疗服务价格调整模型,测算并实证分析医疗服务价格调整方案,提出相应的政策建议,为理顺广东省医疗服务价格比价关系、推进医疗服务价格改革提供决策支持。研究方法本课题采用的研究方法包括:文献资料法、问卷调查法、描述性统计分析法、对比分析法、专家咨询法、实证分析法。研究结果1.医疗服务价格调整方案:在测算价格调整总盘的基础上,根据价格理论、价格政策、各省市价格调整方案、本次医疗服务价格调整原则和调整范围,共设计A、B两套医疗服务价格调整方案。其中,A、B两套方案中,各分别设计三套子方案,即A-1、A-2、A-3、B-1、B-2、B-3。以方案A-1为例:(1)取消药品加成额和耗材加成额的80%;(2)医学影像、核医学、检验(临床微生物学检查除外)项目价格在现有基础上降低8%;(3)综合医疗服务类项目价格在现有基础上提高34%;(4)临床各系统诊疗、手术治疗、物理治疗与康复、中医及民族医诊疗类项目价格在现有基础上提高30%;(5)病理检查(分子病理学诊断技术除外)项目价格在现有基础上提高9%;(6)超声检查、放射治疗、血型与配血、经血管介入诊疗项目不调价。2.医疗服务价格调整方案具有合理性和可行性。10家医院实证结果显示,方案A-1、A-2、A-3、B-1、B-2、B-3“医疗服务价格调整前后比值”均值分别为 100.71%、100.72%、100.66%、100.78%、100.91%、100.94%,均在 95%-105%的合理区间内。政策建议1.价格调整一次到位;2.采用上海、江苏模式;3.医疗服务价格高于广东省已改革试点城市;4.建立动态价格评价与调价机制;5.逐步对接和实施2012年版;6.推进药品、耗材流通领域改革;7.建立预警机制和应急基金。
[Abstract]:Since the new medical reform was launched in 2009, the reform of compensation mechanism in public hospitals and the reform of price formation mechanism of medical services have gradually become the core task of the medical reform. Various localities are also continuing to carry out pilot reforms. Since 2012, China has accelerated the reform of pharmaceutical prices in public hospitals. In July 2016, The National Development and Reform Commission and other four departments jointly issued the notice on promoting the Reform of the prices of Medical Services (No. 1431), which states that China will follow the requirements of "total volume control, structural adjustment, rise and fall, step by step". Promote the reform of medical service price in an all-round way, thus set off a new wave of reform of medical service price. At present, some provinces and cities in China, such as Beijing, Shanghai, Jiangsu, Anhui, etc., have been in the forefront of medical service price reform, Guangdong Province only Shenzhen, Zhongshan, Dongguan, Zhuhai to carry out pilot work. Although Guangdong Province has achieved positive results in deepening the reform of medical service prices, the price of medical services has not yet been straightened out, the management mode still needs to be improved, and the price behavior needs to be further standardized. Therefore, this research comprehensively combs the related pricing theory and the pricing method, according to the national related medical service price reform document spirit request, draws lessons from the foreign advanced practice and our country has carried on the medical price reform province and city experience, On the basis of the collection and analysis of the data of the economic base of Guangdong Province in Guangzhou over the past three years, the adjustment principles, the scope and the range of adjustment of the medical service prices of the municipal public hospitals in Guangdong Province have been studied. This paper constructs a model of medical service price adjustment, calculates and empirically analyzes the adjustment scheme of medical service price, puts forward corresponding policy recommendations, and provides decision support for straightening out the relationship between medical service price and price ratio in Guangdong Province and promoting the reform of medical service price. The research methods used in this paper include: literature method, questionnaire survey, descriptive statistical analysis, comparative analysis, expert consultation, and empirical analysis. Results 1. Medical service price adjustment scheme: on the basis of calculating the total price adjustment, according to the price theory, price policy, provincial and municipal price adjustment plan, the principle and scope of this medical service price adjustment, Two sets of medical service price adjustment schemes were designed. In each of the two sets of schemes, three sets of schemes are designed, namely, A-1C, A-2N, A-3N, B-1, B-2, and B-3, respectively. Take scenario A-1 as an example: 1) canceling 80% of the addition of drugs and consumables) Medical imaging, nuclear medicine, The item price of examination (except clinical microbiology examination) is reduced by 8% on the existing basis) the price of comprehensive medical service item increases 34% on the existing basis) the diagnosis and treatment, surgical treatment, physiotherapy and rehabilitation of clinical system, The price of diagnostic and therapeutic items of traditional Chinese medicine and ethnic medicine is increased by 30% on the existing basis) pathological examination (except molecular pathological diagnosis technology) item price is increased by 9% on the existing basis) ultrasonic examination, radiation therapy, blood type and blood matching, The item of transvascular interventional diagnosis and treatment is not adjusted. 2. The results of the empirical study in 10 hospitals showed that the average value of the price adjustment scheme A-1 / A / B / B / B / B / B / B 3 was 100.71 / 100.77 / 100.66 / 100.78 / 100.941 / 100.94, respectively, which was in the reasonable range of 95-105%. The average value of the scheme was 100.71 / 100.66 / 100.78 / 100.941 / 100.94, respectively, in the reasonable range of 95-105%. Policy recommendation 1. Price adjustment once in place. Adopt Shanghai and Jiangsu model. The price of medical services is higher than that of Guangdong Province's reformed pilot city of 4. 4%. Establish dynamic price evaluation and price adjustment mechanism. Step by step docking and implementation of the 2012 version of 6. Promoting the reform in the field of circulation of pharmaceuticals and consumables. Establish early warning mechanism and contingency fund.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1

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