某军队医院有偿医疗服务补偿机制研究

发布时间：2018-01-21 18:20

本文关键词： 军队医院有偿医疗服务补偿机制　出处：《安徽医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：新医改中明确指出要推进公立医院补偿机制改革，逐步将公立医院补偿由服务收费、药品加成收入和财政补助三个渠道改为服务收费和财政补助两个渠道。目前我国公立医院补偿机制的探索路径较多，但对军队医院这类特殊公立医院的补偿机制研究较少。本研究首先界定了军队医院的特殊性，对内为军服务是保障福利性质，对外提供有偿医疗服务是公益福利性质。正是由于军队医院的双重属性，其补偿机制较一般公立医院更为复杂。本研究探讨了公立医院社会补偿与个人补偿中存在的共性问题，在公立医院补偿机制改革的背景下，紧密结合军队医院补偿机制的特殊性，从多方面研究军队医院有偿医疗服务补偿机制的改革，并与其他改革措施紧密结合，从而在一定程度上对公立医院补偿机制改革研究的理论体系进行了有益补充。本研究以某军队医院有偿医疗服务的补偿现状进行案例分析，深入、具体地分析其补偿主体、补偿方式以及补偿额的情况，发现其有偿医疗服务补偿机制中存在以下问题：第一，军队医院为地方病人服务，在一定程度上共享国防费资源，且增加军队医院的服务成本支出，但军队医院没有得到地方政府财政补偿；第二，，新医改即将推行的取消药品加成、改为收取一定金额药事费与医事费等政策，将会给包括军队医院在内的公立医院带来不可避免的政策性损失；第三，由于医疗保险制度中补偿机制的不尽合理，军队医院与地方公立医院都对医疗费用的控制不尽理想。结合国内外文献回顾性分析，笔者提出具体的解决方案，建立某军队医院有偿医疗服务补偿机制的要点与主体框架。首先，确定军队医院有偿医疗服务补偿主体主要为地方政府、社会和个人三方；其次，医疗保险即社会补偿方式应致力于有效地激励医务人员提升医疗服务效率，控制医疗费用，按疾病诊断分类进行定额预付制补偿，有效约束医院的医疗服务行为；最后，超出基本医疗保险范围的自费项目部分，其个人支付（补偿）应增加劳务价值成本，以客观体现医务人员的劳务价值。本研究不仅丰富了公立医院补偿机制改革研究的理论体系，还为新一轮的医疗体制改革提供了相应的政策参考和科学建议。为保证军队医院有偿医疗服务补偿机制的有效运行，地方政府应充分考虑军队医院有偿医疗服务的特殊性，适度履行政府财政补偿责任，同时，应对军队医院与地方公立医院一视同仁，促进医疗保险的全面覆盖和异地即时结算，为解决全民医疗问题奠定坚实的基础。另外，应加快推进医疗保险支付方式的改革，使之成为约束包括军队医院在内的公立医院医疗服务行为的有效手段。理顺军队医院对外有偿医疗服务补偿机制，增加军队医院改善与提高医疗服务效率与水平的动力，向着优质高效的方向发展，更好地适应国家卫生事业改革前进的步伐。
[Abstract]:In the new medical reform, it is clearly pointed out that we should promote the reform of the compensation mechanism of public hospitals and gradually charge public hospitals for compensation from services. The three channels of drug supplement income and financial subsidy are changed into two channels: service charge and financial subsidy. At present, there are many ways to explore the compensation mechanism of public hospitals in our country. However, there are few researches on the compensation mechanism of special public hospitals such as military hospitals. Firstly, this study defines the particularity of military hospitals, and the nature of internal service for the military is the nature of ensuring welfare. It is the nature of commonweal welfare to provide paid medical services to foreign countries. It is precisely because of the dual attributes of military hospitals. The compensation mechanism is more complex than the general public hospital. This study discusses the common problems in the public hospital social compensation and individual compensation, under the background of the public hospital compensation mechanism reform. Closely combined with the particularity of the compensation mechanism of military hospitals, this paper studies the reform of compensation mechanism of paid medical services in military hospitals from many aspects, and closely combines with other reform measures. To a certain extent, the theoretical system of the reform of compensation mechanism in public hospitals is supplemented. This study is based on the case study of the compensation status of paid medical service in a military hospital, and analyzes the main body of compensation, the compensation method and the compensation amount in detail. It is found that there are the following problems in the compensation mechanism of paid medical services: first, military hospitals serve local patients, share defense expenditure resources to a certain extent, and increase the service cost expenditure of military hospitals. But the military hospital did not get the local government financial compensation; Second, the new medical reform will be implemented to cancel the drug addition, instead of charging a certain amount of drug and medical expenses, which will bring inevitable policy losses to the public hospitals, including military hospitals; Third, because of the unreasonable compensation mechanism in the medical insurance system, both military hospitals and local public hospitals are imperfect in controlling medical expenses. Based on the retrospective analysis of domestic and foreign literature, the author puts forward specific solutions to establish the main points and main framework of compensation mechanism of paid medical service in a military hospital. The main body of compensation for paid medical service in military hospital is mainly local government, society and individual. Secondly, medical insurance, that is, social compensation, should be devoted to effectively encourage medical personnel to improve the efficiency of medical services, control medical expenses, and carry out prepaid compensation according to the classification of disease diagnosis. Effectively restrain the medical service behavior of the hospital; Finally, the individual payment (compensation) should increase the cost of labor service value in order to objectively reflect the service value of medical personnel. This study not only enriches the theoretical system of public hospital compensation mechanism reform. It also provides the corresponding policy reference and scientific advice for the new round of medical system reform and ensures the effective operation of the compensation mechanism of paid medical service in military hospitals. The local government should give full consideration to the particularity of the paid medical service in the military hospital and appropriately fulfill the responsibility of the government financial compensation. At the same time, the military hospital and the local public hospital should be treated equally. To promote the comprehensive coverage of medical insurance and real-time settlement in different places, so as to lay a solid foundation for solving the medical problems of the whole people. In addition, we should speed up the reform of payment methods of medical insurance. Make it become the effective means to restrain the medical service behavior of the public hospitals including military hospitals and straighten out the compensation mechanism of the external paid medical services of military hospitals. To increase the motive force of improving and improving the efficiency and level of medical service in military hospitals, to develop towards the direction of high quality and efficiency, and to better adapt to the pace of the reform of national health care.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R82

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