本文選題：醫(yī)療保險 + 付費方式改革��； 參考：《內蒙古大學》2017年碩士論文

【摘要】：醫(yī)療保險的基本問題在于,醫(yī)療保險服務方對醫(yī)保資金的要求無限增長,為滿足患者的醫(yī)療需求,增加成本和利益收入,醫(yī)療保險支付方要在有限的醫(yī)保資金的情況下,滿足服務方的要求,還不能降低對患者的服務要求。付費方式作為醫(yī)療保險管理的手段,是平衡參保人員、醫(yī)療機構利益關系的關鍵性政策,是調節(jié)醫(yī)療服務行為的經濟杠桿;提高醫(yī)療保險基金的撥付和使用,使患者可以享受醫(yī)療保險服務,體現政府治理的積極作用,是實現醫(yī)療保險制度可持續(xù)發(fā)展的重要支點,也是醫(yī)保管理機構的天然使命。本研究首先詳細介紹了醫(yī)療保險付費方式和改革相關的概念和改革的必要性分析,烏海市醫(yī)療保險付費方式改革進程以及對存在的問題分析,從而提出,促進烏海市醫(yī)療保險付費方式改革對策建議,主要包括加強政府主導與部門協(xié)作關系、完善經辦管理的支付方式、加強付費方式改革的機制建設、加強基金預算管理、加強協(xié)議管理、發(fā)揮信息系統(tǒng)建設的基礎支撐作用等。不同的付費方式會引導產生不同的醫(yī)療服務行為,沒有哪一種付費方式是萬能的,在選擇了一種付費方式的優(yōu)勢時,同時也要面對這種付費方式的弊端。醫(yī)療保險管理者要充分了解各種付費方式的特征,預見其可能產生的后果,并采取相應的有針對性的管理措施,才能充分發(fā)揮付費方式引導醫(yī)療服務行為和控制醫(yī)療費用的積極作用,避免或減輕不利影響。從而保證經辦管理的嚴格,比如協(xié)議管理、醫(yī)保醫(yī)師管理、醫(yī)療監(jiān)控管理等措施相結合,形成一個系統(tǒng)工程,達到醫(yī)�；鹗罩胶獾囊�。
[Abstract]:The basic problem of medical insurance is that the demand for medical insurance funds by medical insurance providers is increasing indefinitely. In order to meet patients' medical needs, increase costs and benefit income, medical insurance payers should have limited medical insurance funds. To meet the requirements of the service side, can not reduce the service requirements for patients. As a means of medical insurance management, payment method is a key policy to balance the interests of insured personnel and medical institutions, is to regulate the economic leverage of medical service behavior, and to improve the allocation and use of medical insurance funds. It is an important fulcrum to realize the sustainable development of medical insurance system to make patients enjoy medical insurance service and reflect the positive role of government governance. It is also the natural mission of medical insurance management organization. This study firstly introduces the concept and necessity of medical insurance payment mode and reform, the reform process of Wuhai medical insurance payment system and the analysis of the existing problems. The countermeasures and suggestions to promote the reform of medical insurance payment mode in Wuhai City mainly include strengthening the relationship between the government leading and the departments, perfecting the payment mode of the administrative management, strengthening the mechanism construction of the reform of the payment mode, and strengthening the fund budget management. Strengthen the agreement management, give play to the basic supporting role of the information system construction and so on. Different payment methods will lead to different medical service behavior, no payment is omnipotent, in the choice of the advantages of a payment method, but also to face the drawbacks of this way of payment. Medical insurance administrators should fully understand the characteristics of various payment methods, foresee the possible consequences, and take appropriate targeted management measures. Only in order to give full play to the positive role of paying way to guide medical service behavior and control medical expenses, to avoid or mitigate the adverse effects. In order to ensure strict management, such as agreement management, medical care physician management, medical monitoring management and other measures combined to form a system engineering, to meet the requirements of health insurance fund income and expenditure balance.
【學位授予單位】：內蒙古大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R197.1;F842.684

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