福建省药品零差率销售政策对农村患者医疗费用的影响研究

发布时间：2018-06-08 08:18

本文选题：药品零差率销售政策 + 医疗费用　；参考：《福建农林大学》2017年硕士论文

【摘要】：长期以来,"看病难"、"看病贵"都是困扰群众生活的一个重要问题。而药价过高问题是农民"看病贵"的一个重要原因,且大多数农村患者的医药支付方式为新农合,门诊报销的比例较低,农民"因病致贫、因病返贫"的现象屡有发生。我国自2009年开始以试点形式在全国范围内开展药品零差率销售政策,通过以"药改"的方式推动"医改",促使整个医疗体系的改革。当前,医疗费用的不断上升,引起了越来越多人的关注,本文对药品零差率销售政策的实施对医疗费用支出的影响展开研究。本文通过对国家基本药物制度和福建省基本药品零差率销售相关政策的梳理,旨在分析实行药品零差率后对医疗机构药品价格的影响情况以及对农村患者医疗费用负担的影响,并且对当前福建省的药品零差率实施的可行性进行判断研究,为进一步完善基本药品零差率销售及相关政策提供客观依据。本文参考了大量文献研究采用统计学分析法对福州市2009-2015年的新农合医保病例医疗费用的数据,构建农村患者次均门诊费用的时间序列预测模型;通过抽样调查农村居民年医疗费用支出情况,结合医疗费用支出的多种影响因素建立面板数据多元回归线性模型。研究结果表明:药品零差率销售政策的实施在控制药品价格上涨上取得一定的成效,药占比有下降的趋势,但是对于农村患者的次均门诊费用没有起到降低的效果。药品零差率政策与农村居民医疗费用负担存在正相关,说明药品零差率销售政策实施后没有减轻农村居民的医疗费用负担。经过讨论分析,发现在取消药品加成率的同时也提高了医疗服务的费用,导致农村居民实际医疗费用支出没有下降。本研究对此提出了政策建议,推动城市优质医疗卫生资源向基层延伸,提高农村居民收入;完善补偿机制,只有提高政府投入才能有效保障医疗机构的政策运行,减少医生、医院对药品收入的依赖;正确引导和推进药品零差率政策的实施,需要建立起一个完善的监督管理体制,才能有效保障医疗机构卫生服务事业健康有序地发展;完善医保支付体制改革,建立医疗保险项目的价格体系。
[Abstract]:For a long time, "difficult to see a doctor" and "expensive to see a doctor" have been an important problem puzzling people's life. The problem of high drug price is an important reason for farmers to "see a doctor expensive", and most rural patients' medical payment method is the new rural cooperative, the proportion of outpatient reimbursement is low, the phenomenon of farmers "poor because of illness, return to poverty because of illness" often occurs. Since 2009, our country began to carry out the policy of zero difference rate of drug sales in the whole country in the form of pilot in 2009, and promote the reform of the whole medical system through the way of "drug reform". At present, more and more people pay more and more attention to the rising medical expenses. This paper studies the effect of the implementation of the zero difference rate of drug sales policy on medical expenses. By combing the national essential drug system and the related policies of Fujian Province, this paper aims to analyze the influence of the implementation of the zero difference rate on the drug prices of medical institutions and the impact on the burden of medical expenses of rural patients. And the feasibility of the implementation of drug zero difference rate in Fujian Province is judged and studied, which provides an objective basis for the further improvement of the sales of essential drugs and related policies. Referring to a large number of literature studies, this paper uses statistical analysis method to analyze the medical expenses of new rural cooperative medical insurance cases from 2009 to 2015 in Fuzhou, and constructs a time series prediction model of rural patients' outpatient expenditure. A multivariate regression linear model of panel data was established by sampling the annual medical expenditure of rural residents and combining with various influencing factors of medical expenditure. The results show that the implementation of the policy of zero difference rate of drug sales has achieved some results in controlling the increase of drug prices, and the proportion of drugs has a downward trend, but the average outpatient expenses of rural patients have not been reduced. There was a positive correlation between the policy of zero difference rate of drugs and the burden of medical expenses of rural residents, which indicated that the implementation of the policy of zero difference rate of drugs sales did not reduce the burden of medical expenses of rural residents. After discussion and analysis, it is found that the cost of medical service is increased while the drug addition rate is cancelled, which leads to the fact that the actual medical expenses of rural residents have not decreased. This study puts forward some policy suggestions to promote the urban high-quality medical and health resources to extend to the grass-roots level, to improve the income of rural residents, to improve the compensation mechanism, only by increasing government input to effectively ensure the policy operation of medical institutions and reduce the number of doctors. It is necessary to establish a perfect supervision and management system to ensure the healthy and orderly development of health service in medical institutions. We will improve the reform of the medical insurance payment system and establish a price system for medical insurance items.
【学位授予单位】：福建农林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R95

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