按病种付费机制对医疗费用的影响研究

发布时间：2018-01-23 07:54

本文关键词： 医疗保险新型农村合作医疗按病种付费双重差分模型　出处：《中国科学技术大学》2017年硕士论文　论文类型：学位论文

【摘要】：在我国当前的医疗保险制度下,"看病难,看病贵"一直是全国民众和各类相关机构所头疼的问题。医疗服务费用的增加,进而会增加病患的经济负担,从而会进一步恶化当前的医患关系。想要提高全民的医疗保障水平,促使我国医疗保障制度进一步完善,以医疗费用支付方式为切入点进行医疗保障制度改革是当前医疗改革的重要一环。目前我国新型农村合作医疗的发展面临着要以较低的筹资水平来提高医疗保障水平的挑战。按病种付费机制是一项以病种分组和定价为技术核心的医疗保险支付方式,根据国际经验显示,按病种付费机制可以有效控制不合理的医疗费用增长,同时还能在提高医疗服务质量和效率等方面能够发挥积极作用。我国在新型农村合作医疗制度建立以及推广初期就开始积极探索和实施按病种付费机制改革。安徽省新农合作为我国新农合的重要成员,当前其医保基金已经面临透支的风险,原定的给医疗机构以定额补贴的补偿方式面临着严峻考验,各类补贴定额是否合理、医保基金是否存在浪费这一系列问题亟待解决。根据安徽省新农合所面临的问题,本研究以安徽省县级行政区医疗机构为研究对象,运用文献分析、描述性统计分析、双重差分模型以及稳健性检验等工具,首先对当前安徽省新农合目前实行按病种付费的方式进行了分析。目前安徽省新农合实施的按病种付费机制的一项具体手段是自己编制一套新的疾病代码系统,并与国际上通用的ICD-10编码构成一一对应的关系,并以新的编码系统作为执行按病种付费机制的基准。其次,本研究在此基础上分析了按病种付费机制对安徽省县级行政区域医疗机构的医疗服务费用的影响情况,并得出定量的研究结果。在此之后,本研究对当前的研究结果进行了检验,得出对于不同疾病,按病种付费机制会有不同的效果。最后,本研究给出了当前研究的拓展方向,并给出新农合改进按病种付费机制的相关建议。
[Abstract]:Under the current medical insurance system of our country, "difficult to see a doctor, expensive to see a doctor" has always been a headache for the people of the whole country and all kinds of related institutions. The increase in the cost of medical services will increase the economic burden of patients. This will further worsen the current doctor-patient relationship. Want to improve the level of medical security of the whole people, promote the further improvement of our medical security system. The reform of medical security system based on the payment of medical expenses is an important part of the current medical reform. At present, the development of the new rural cooperative medical system in China is facing the need to raise medical security at a lower level of financing. The payment mechanism by disease category is a medical insurance payment method with disease grouping and pricing as the core technology. According to international experience, the mechanism of paying for diseases can effectively control the unreasonable increase of medical costs. At the same time, it can also play a positive role in improving the quality and efficiency of medical service. Our country has been actively exploring and implementing the reform of the payment mechanism according to disease in the early stage of establishing and popularizing the new rural cooperative medical system. Huizhou New Rural Cooperation is an important member of China's New Rural Cooperation (NCMS). At present, its health insurance fund has been faced with the risk of overdraft, the original compensation to medical institutions with quota is facing a severe test, all kinds of subsidy quota is reasonable. According to the problems faced by the New Rural Cooperation in Anhui Province, this study takes the medical institutions of the county-level administrative region of Anhui Province as the research object, using literature analysis. Descriptive statistical analysis, double difference model and robustness test. First of all, this paper analyzes the current implementation of the new agricultural cooperation in Anhui Province according to the disease payment method. At present, a specific means of Anhui new agricultural cooperation by disease payment mechanism is to compile a new disease code system. And with the international common ICD-10 coding form a one-to-one correspondence, and the new coding system as the implementation of the payment mechanism by disease benchmark. Secondly. On this basis, this study analyzed the effect of the disease payment mechanism on the medical service cost of the county administrative medical institutions in Anhui province, and obtained the quantitative research results. In this study, the current research results are tested, and it is concluded that the pay mechanism according to disease will have different effects for different diseases. Finally, this study gives the development direction of the current research. It also gives some suggestions on how to improve the payment mechanism by disease.
【学位授予单位】：中国科学技术大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1;F842.684

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