县级公立医院补偿机制改革对医院经济运行影响的研究
发布时间：2018-07-31 13:59
【摘要】：改革开放以来我国医药卫生体制改革已经走过了30多年的历程,在我国的医药卫生体制中,医院是联结政府、医保、药品供应、社区医疗卫生与群众的纽带,改革的许多政策都要通过医院来实现。县级公立医院是县级行政区域内医疗卫生服务体系的龙头和主体,是当前医改的重点和难点[1]。2009年,我国新医改正式拉开序幕,公立医院补偿机制改革作为新医改的主要任务之一,正式提到了医改的议事日程。2013年,以破除“以药补医”机制为关键环节,以改革补偿机制为切入点,我国在311个试点县市全面推开县级公立医院综合改革。县级公立医院综合改革是从改革补偿机制入手,即取消药品加成、完善政府财政补偿、调整医疗服务价格。以改革补偿机制为前提的改革必将会影响医院的经济运行状况,进而影响医院未来的发展。本研究通过对山东省县级公立医院补偿机制改革前后医院经济运行状况进行比较分析和探讨,为医院的可持续发展提供理论和实践依据。本研究阐述了公立医院补偿机制改革的相关理论基础,梳理了公立医院补偿机制的相关概念及模式,介绍了县级公立医院补偿机制改革与发展的基本内容。通过山东省县级公立医院综合改革监测网,收集本研究所需要的定量及定性资料,通过excel软件进行数据的录入和整理。采用正态性检验、方差齐性检验、T检验、Mann-Whitney u检验以及描述性统计方法分析补偿机制改革前后县级公立医院经济运行状况。通过样本县级公立医院相关数据的处理分析,县级公立医院补偿机制改革的成效和问题并存,医院财政补助收入增长明显,但占医院总收入的比重仍较低,药品收入所占比重有较大幅度的下降。公立医院补偿机制改革对县级公立医院经济效益产生明显的影响,但医院服务效率未明显改善。补偿机制改革存在一定的时间效应,短期效果并没有显著性差异,仍需要进一步研究。
[Abstract]:More than 30 years have passed since the reform and opening up of China's medical and health system. In the medical and health system of our country, hospitals are the link between the government, medical insurance, drug supply, community medical and health care and the masses. Many of the policies of the reform have to be implemented through hospitals. The county-level public hospitals are the leading and main body of the medical and health service system in the county-level administrative regions, and are the key and difficult points of the current medical reform [1]. In 2009, the new medical reform of our country officially kicked off. As one of the main tasks of the new medical reform, the reform of the compensation mechanism in public hospitals has been formally mentioned in the agenda of the medical reform. In 2013, the key link was to break the mechanism of "taking medicine as a supplement", and the reform of the compensation mechanism was regarded as the starting point. In 311 pilot counties and cities, comprehensive reform of county-level public hospitals has been fully promoted. The comprehensive reform of county-level public hospitals begins with the reform of compensation mechanism, that is, the cancellation of drug addition, the improvement of government financial compensation, and the adjustment of medical service prices. The reform on the premise of reforming the compensation mechanism will affect the economic operation of the hospital and then affect the future development of the hospital. Through the comparative analysis and discussion on the economic operation of the hospitals before and after the reform of the compensation mechanism of the county-level public hospitals in Shandong Province, this study provides a theoretical and practical basis for the sustainable development of hospitals. This paper expounds the theoretical basis of the public hospital compensation mechanism reform, combs the relevant concepts and models of the public hospital compensation mechanism, and introduces the basic content of the county level public hospital compensation mechanism reform and development. Through the comprehensive reform monitoring network of county-level public hospitals in Shandong Province, the quantitative and qualitative data needed in this study were collected, and the data input and collation were carried out by excel software. The normal test, variance homogeneity test and Mann-Whitney u test were used to analyze the economic operation of county-level public hospitals before and after the reform of compensation mechanism. Through the processing and analysis of the sample data of county-level public hospitals, the results and problems of the compensation mechanism reform of county-level public hospitals coexist, and the financial subsidy income of hospitals increases obviously, but the proportion of total hospital income is still relatively low. The proportion of drug income has decreased by a large margin. The reform of compensation mechanism of public hospitals has a significant impact on the economic benefits of county-level public hospitals, but the efficiency of hospital services has not been significantly improved. There is a certain time effect in the reform of compensation mechanism, but there is no significant difference in the short-term effect.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R197.322
本文编号：2155805
[Abstract]:More than 30 years have passed since the reform and opening up of China's medical and health system. In the medical and health system of our country, hospitals are the link between the government, medical insurance, drug supply, community medical and health care and the masses. Many of the policies of the reform have to be implemented through hospitals. The county-level public hospitals are the leading and main body of the medical and health service system in the county-level administrative regions, and are the key and difficult points of the current medical reform [1]. In 2009, the new medical reform of our country officially kicked off. As one of the main tasks of the new medical reform, the reform of the compensation mechanism in public hospitals has been formally mentioned in the agenda of the medical reform. In 2013, the key link was to break the mechanism of "taking medicine as a supplement", and the reform of the compensation mechanism was regarded as the starting point. In 311 pilot counties and cities, comprehensive reform of county-level public hospitals has been fully promoted. The comprehensive reform of county-level public hospitals begins with the reform of compensation mechanism, that is, the cancellation of drug addition, the improvement of government financial compensation, and the adjustment of medical service prices. The reform on the premise of reforming the compensation mechanism will affect the economic operation of the hospital and then affect the future development of the hospital. Through the comparative analysis and discussion on the economic operation of the hospitals before and after the reform of the compensation mechanism of the county-level public hospitals in Shandong Province, this study provides a theoretical and practical basis for the sustainable development of hospitals. This paper expounds the theoretical basis of the public hospital compensation mechanism reform, combs the relevant concepts and models of the public hospital compensation mechanism, and introduces the basic content of the county level public hospital compensation mechanism reform and development. Through the comprehensive reform monitoring network of county-level public hospitals in Shandong Province, the quantitative and qualitative data needed in this study were collected, and the data input and collation were carried out by excel software. The normal test, variance homogeneity test and Mann-Whitney u test were used to analyze the economic operation of county-level public hospitals before and after the reform of compensation mechanism. Through the processing and analysis of the sample data of county-level public hospitals, the results and problems of the compensation mechanism reform of county-level public hospitals coexist, and the financial subsidy income of hospitals increases obviously, but the proportion of total hospital income is still relatively low. The proportion of drug income has decreased by a large margin. The reform of compensation mechanism of public hospitals has a significant impact on the economic benefits of county-level public hospitals, but the efficiency of hospital services has not been significantly improved. There is a certain time effect in the reform of compensation mechanism, but there is no significant difference in the short-term effect.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R197.322
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