基于公益性的医疗服务定价机制研究

发布时间：2018-03-15 02:16

本文选题：公益性　切入点：医疗服务定价　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:针对我国医疗服务价格体系存在的问题,本文围绕着“公立医院公益性”,探索医疗服务定价的新思路,从而为政府进一步理顺医疗服务比价关系提供指导。方法:对已有的文献资料进行归纳整理,同时结合专家访谈法,根据专家访谈的意见对需要进行调查的问卷加以改进完善,初步拟定专家咨询问卷;通过三轮专家咨询法,分别针对医疗服务项目的医学准则刚性、活劳动强度,对医疗服务项目指标进行分类,在完成分类的基础上制定不同定价原则;使用专家的积极系数、权威程度以及协调系数来说明医疗服务指标分类的科学与可靠性;利用SPSS21.0软件,应用t检验探讨分析腔镜手术与传统开刀手术的手术室费用结构情况,从而进一步反映目前的医疗服务比价关系状况。结果:经过三轮专家咨询,分别针对医疗服务项目的医学准则刚性、活劳动强度完成了43个指标的分类。其中,第一轮专家的积极系数分别为97.44%,第二轮专家的积极系数为94.06%,第三轮专家的积极系数为100.00%;专家权威程度为0.8490。第一轮专家咨询中指标的医学准则刚性和活劳动强度的专家协调系数分别为0.626(X~2=985.428,PO.001)和0.431(X~2=670.353,PO.001);第二轮专家咨询中指标的医学准则刚性和活劳动强度的专家协调系数分为0.597(X~2=998.125,PO.001)和0.527(X~2=650.218,PO.001);第三轮专家咨询中指标的医学准则刚性和活劳动强度的专家协调系数分为0.538(X~2=1028.511,PO.001)和0.460(X~2=636.947,PO.001)。另外,通过对所调取的常见手术的手术室费用及结构进行分析,同医疗服务价格调整前相比较,在青岛市医疗服务价格调整后的手术室总费用中,手术费、麻醉费等技术劳务费均有增加,而且从费用结构来看,技术劳务费的构成比上涨是较大的,而一次性耗材的费用及其所占手术室费用的比例是明显下降的,此外,检查、监测费也是略有下降的。但是,一次性耗材费、检查、监测等非技术劳务费及其比例仍明显高于技术劳务费,其中以一次性耗材费最为显著。结论:在按项目收费的现实前提下,为医学准则刚性强的医疗服务项目构筑经济空间,有利于激励医疗服务供给者的公益性行为;对医学准则刚性弱、医生自由选择程度大的医疗服务项目实行缩小收益空间,甚至收益接近于(等于)或小于成本的定价,有助于引导医疗服务提供者坚持以患者为中心,根据医疗需要,而不是根据经济利益获取的公益性行为;医疗服务价格的调整虽然进一步理顺了医疗服务比价关系,但是关于医务人员的技术劳务价值还有待于进一步合理体现。
[Abstract]:Objective: in view of the problems existing in the price system of medical services in China, this paper focuses on the "public welfare of public hospitals" and explores a new way of pricing medical services. So as to provide guidance for the government to further straighten out the relationship between medical services and price. Methods: the existing literature and materials are summarized and sorted, and the questionnaire that needs to be investigated is improved and perfected according to the opinions of expert interviews and combined with the method of expert interviews. Through three rounds of expert consultation, aiming at the rigidity of medical standards and the intensity of living labor of medical service items, the indexes of medical service items are classified, and different pricing principles are worked out on the basis of the classification. The positive coefficient of experts, the degree of authority and the coordination coefficient are used to explain the scientific and reliability of the classification of medical service index, and the cost structure of operating room for endoscopic surgery and traditional operation is analyzed by using SPSS21.0 software and t-test. Results: after three rounds of expert consultation, 43 indexes were classified according to the rigidity of medical standards and live labor intensity of medical service items. The positive coefficient of experts in the first round is 97.44, the positive coefficient in the second round is 94.06 and the positive coefficient in the third round is 100.00.The degree of authority of the experts is 0.8490. The coordination coefficient of experts is 0.626 X ~ (2 +) ~ (985.428) (P _ (001)) and 0.431X ~ (2) ~ (2) ~ (67) 0.353 ~ (3) P _ (001); the coefficient of expert coordination for the rigidity of medical criteria and the intensity of live labor for the indicators in the second round of expert consultation are 0.597X ~ (2) (998.125PO. 001) and 0.52727X _ (2) (650.2N _ (650.218PO _ (001)); the rigidity of medical criteria and the intensity of live labor in the third round of expert consultation. The expert coordination coefficients of the two groups are 0.538, XX, 1028.511, PO.001, and 0.460, XG, 2636.947, PO.001. in addition, By analyzing the operating room cost and structure of the common operation, compared with that before the adjustment of the medical service price, the operating expenses of the operating room after the adjustment of the medical service price in Qingdao City were analyzed. The cost of technical services, such as anesthesia, has increased, and in terms of the cost structure, the composition of the cost of technical labour is higher, while the cost of disposable consumables and their share in operating room costs have decreased significantly. In addition, inspections, However, non-technical labor costs, such as one-time consumables, inspections, monitoring, and their proportion are still significantly higher than those of technical labour. Conclusion: under the realistic premise of charging according to the project, the economic space for the medical service project with strong rigidity is built, which is helpful to encourage the public welfare behavior of the medical service provider. A narrowing of revenue space or even pricing of benefits close to (equal to) or less than the cost of medical services, which are weak in the rigidity of medical guidelines and a large degree of doctor's free choice, can help to guide medical service providers to adhere to patient-centered approaches. According to the medical needs, not the public welfare behavior obtained according to the economic benefits; the adjustment of the medical service price has further straightened out the relationship between the medical service price and the medical service price. However, the technical labor value of medical personnel needs to be further and reasonably reflected.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1

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