京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時結(jié)報的利益相關者分析
發(fā)布時間：2018-09-08 18:44
【摘要】：研究目的本研究旨在了解京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時結(jié)報的基本情況,進而分析即時結(jié)報過程中涉及的主要利益相關者,探究主要利益相關者與京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時結(jié)報之間的影響,從而為京津冀地區(qū)跨省就醫(yī)即時結(jié)報工作提供建議。研究內(nèi)容1.梳理異地就醫(yī)即時結(jié)報、利益相關者的相關概念、內(nèi)涵、理論和國內(nèi)外研究現(xiàn)狀、實踐經(jīng)驗。2.分析京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時結(jié)報的政策制度、信息技術、業(yè)務流程和結(jié)算方式,并歸納所面臨的主要問題。3.利用利益相關者分析方法,分析京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時結(jié)報的主要利益相關者的關聯(lián)程度、執(zhí)行意愿和政策影響力。4.探討主要利益相關者與京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時結(jié)報之間的影響,結(jié)合即時結(jié)報存在問題與利益相關者分析結(jié)果,提出相應的建議。研究方法1.資料來源:(1)文獻研究:通過在中外文獻數(shù)據(jù)庫以及政府門戶網(wǎng)站檢索與研究主題相關的文獻資料,系統(tǒng)梳理相關理論和國內(nèi)外實踐;(2)現(xiàn)場調(diào)查:通過問卷調(diào)查及半結(jié)構(gòu)式訪談,了解京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時結(jié)報的政策制定及實施狀況。2.研究方法:(1)利益相關者分析法:確定京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時結(jié)報工作中涉及的主要利益相關者,并利用分析指標,借助問卷調(diào)查和深入訪談,了解各主要利益相關者的特征;(2)專家咨詢法:先后在設計調(diào)查問卷、確定利益相關者、確定主要利益相關者及確定分析指標階段咨詢專家學者;(3)描述性統(tǒng)計分析法:對問卷調(diào)查、深入訪談和專家咨詢中收集的定性、定量資料運用常用的統(tǒng)計學方法處理分析。結(jié)果1.京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時結(jié)報的基本情況政策制度方面,京津冀三地的統(tǒng)籌補償政策、報銷政策呈現(xiàn)差異化,均強調(diào)轉(zhuǎn)診制度。信息化建設方面,京津冀三地的管理信息系統(tǒng)建設、醫(yī)療機構(gòu)聯(lián)網(wǎng)結(jié)報、結(jié)算平臺建立以及配套信息系統(tǒng)建設存在差異。業(yè)務流程方面,京津冀地區(qū)按照就醫(yī)管理、登記備案、預付金管理、醫(yī)療費用結(jié)算、醫(yī)療費用清算的五個步驟進行。試點應用方面,京津冀地區(qū)目前尚未針對參保農(nóng)民的跨省就醫(yī)即時結(jié)報進行即時結(jié)報試點,但其他領域已設計出“面對面”結(jié)報模式。存在問題方面,京津冀地區(qū)在開展即時結(jié)報工作中面臨著城鄉(xiāng)居民醫(yī)保的統(tǒng)籌層次低且不一、即時結(jié)報的信息化建設參差不齊以及欠缺系統(tǒng)規(guī)劃等主要問題。2.京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時結(jié)報的利益相關者分析京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時結(jié)報的主要利益相關者分別為人社部門、衛(wèi)生行政部門、醫(yī)保經(jīng)辦機構(gòu)、就醫(yī)地醫(yī)療機構(gòu)、參保地醫(yī)療機構(gòu)和參保農(nóng)民。主要利益相關者的角色定位、利益、立場、聯(lián)盟、資源、權力和領導能力的不同程度影響了相關者的關聯(lián)程度、執(zhí)行意愿和政策影響力。人社部門具有高關聯(lián)程度、高政策影響力,持支持態(tài)度;衛(wèi)生行政部門具有低關聯(lián)程度、中等政策影響力,持支持態(tài)度;醫(yī)保經(jīng)辦機構(gòu)具有高關聯(lián)程度、較高政策影響力,持較支持態(tài)度;就醫(yī)地醫(yī)療機構(gòu)具有高關聯(lián)程度、較高政策影響力,持中立態(tài)度;參保地醫(yī)療機構(gòu)具有低關聯(lián)程度、較低政策影響力,持中立態(tài)度;參保農(nóng)民具有高關聯(lián)程度、較低政策影響力,是最大利益受益者,持支持態(tài)度。結(jié)論1.人社部門、醫(yī)保經(jīng)辦機構(gòu)和就醫(yī)地醫(yī)療機構(gòu)與京津冀地區(qū)即時結(jié)報工作關聯(lián)程度高,具有較強的政策影響力,需加強三個部門(機構(gòu))在京津冀地區(qū)即時結(jié)報工作中的執(zhí)行意愿。對于人社部門,需調(diào)動人員的工作積極性以及加強統(tǒng)籌規(guī)劃與協(xié)調(diào)能力;對于醫(yī)保經(jīng)辦機構(gòu),需調(diào)動人員的工作積極性以及規(guī)避醫(yī)保資金風險問題;對于就醫(yī)地醫(yī)療機構(gòu),需確保醫(yī)保報銷費用在規(guī)定時限內(nèi)回款。盡管參保農(nóng)民的政策影響力小,但是作為最大利益受益者,需考慮不同類型參保農(nóng)民的跨省就醫(yī)需求,因人制宜。2.主要利益相關者對京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時結(jié)報的系統(tǒng)規(guī)劃、統(tǒng)籌層次和信息化建設產(chǎn)生影響,而京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時結(jié)報為主要利益相關者帶來了風險監(jiān)管和激勵約束的問題。建議1.協(xié)調(diào)即時結(jié)報工作中主要利益相關者的利益關系;2.逐步提高京津冀地區(qū)基本醫(yī)保制度統(tǒng)籌層次;3.加快信息化建設,為跨省就醫(yī)即時結(jié)報夯實基礎;4.加強風險控制,實施有效監(jiān)管;5.建立考核機制和激勵約束機制;6.樹立整體觀,通過系統(tǒng)規(guī)劃形成制度合力。
[Abstract]:Objective The purpose of this study is to understand the basic situation of the instant report of the insured peasants'cross-provincial medical treatment in Beijing-Tianjin-Hebei region, and then analyze the main stakeholders involved in the process of the instant report, and explore the influence between the main stakeholders and the instant report of the insured peasants' cross-provincial medical treatment in Beijing-Tianjin-Hebei region, so as to make the cross-provincial medical treatment in Beijing-Tianjin- Research contents 1. Combine the related concepts, connotations, theories and research status at home and abroad, practical experience. 2. Analyze the policy system, information technology, business processes and settlement methods of the instant report of the insured peasants in Beijing-Tianjin-Hebei region, and summarize the main problems faced. Key issues. 3. Using stakeholder analysis method, this paper analyzes the correlation degree, willingness to implement and policy influence of the main stakeholders in the instant report of the insured peasants'cross-provincial medical treatment in Beijing-Tianjin-Hebei region. 4. Discusses the influence between the main stakeholders and the instant report of the insured peasants' cross-provincial medical treatment in Beijing-Tianjin-Hebei region. Data sources: (1) Literature research: Systematically combing the relevant theories and practices at home and abroad by searching and researching relevant literature materials in Chinese and foreign literature databases and government portals; (2) Field survey: through questionnaire survey and semi-structured interviews, Methods: (1) Stakeholder analysis: Determine the main stakeholders involved in the work of instant medical report of the insured peasants in Beijing-Tianjin-Hebei region, and use the analysis indicators, with the help of questionnaires and in-depth interviews, to understand the main stakeholders. Characteristics of stakeholders; (2) Expert consultation method: the design of questionnaires to identify stakeholders, identify major stakeholders and determine the stage of analysis indicators consultation experts and scholars; (3) Descriptive statistical analysis: questionnaire survey, in-depth interviews and expert consultation collected in qualitative, quantitative data using commonly used statistical methods Result 1. The basic situation and policy system of the instant medical report of the insured peasants in Beijing-Tianjin-Hebei region, the overall compensation policy and the reimbursement policy in Beijing-Tianjin-Hebei region are different, all of which emphasize the referral system. In the aspect of business process, Beijing-Tianjin-Hebei region has not carried out the real-time settlement test for the cross-provincial medical treatment report of the insured peasants. However, other areas have designed a "face-to-face" reporting model. The existing problems, Beijing-Tianjin-Hebei region in the implementation of immediate reporting work is faced with the low and different levels of urban and rural residents'medical insurance, the information construction of immediate reporting is uneven and the lack of systematic planning and other major issues. 2. Beijing-Tianjin-Hebei region insured farmers cross-province. Stakeholder analysis of medical immediate report in Beijing-Tianjin-Hebei region People's and social sectors have high degree of association, high policy influence and supportive attitude; health administrative departments have low degree of association, medium policy influence and supportive attitude; medical insurance agencies have high degree of association and higher political power. Policy influence and relatively supportive attitude; local medical institutions have high degree of association, higher policy influence and neutral attitude; medical institutions in the insured areas have low degree of association, lower policy influence and neutral attitude; farmers in the insured areas have high degree of association, lower policy influence, and are the biggest beneficiaries of support attitude. Conclusion 1. People's and social departments, medical insurance agencies and local medical institutions have a high degree of correlation with the work of immediate reporting in Beijing-Tianjin-Hebei region, and have a strong policy influence. It is necessary to strengthen the willingness of the three departments (institutions) to implement the work of immediate reporting in Beijing-Tianjin-Hebei region. For medical insurance agencies, it is necessary to mobilize the enthusiasm of staff and avoid the risk of medical insurance funds; for local medical institutions, it is necessary to ensure that the reimbursement fees of medical insurance are paid back within the prescribed time limit. The main stakeholders have an impact on the system planning, overall planning level and information construction of the cross-provincial medical report of the insured peasants in Beijing-Tianjin-Hebei region, while the cross-provincial medical report of the insured peasants in Beijing-Tianjin-Hebei region has brought about the problems of risk supervision and incentive and constraint for the main stakeholders. To coordinate the interests of the major stakeholders in the immediate report; 2. to gradually improve the overall level of the basic medical insurance system in Beijing-Tianjin-Hebei region; 3. to speed up the construction of information technology to lay a solid foundation for the immediate report of inter-provincial medical treatment; 4. to strengthen risk control and implement effective supervision; 5. to establish an assessment mechanism and incentive and restraint mechanism; 6. to establish a holistic view and pass System planning creates a system of synergy.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R197.1;F842.684;F323.89
本文編號：2231373
[Abstract]:Objective The purpose of this study is to understand the basic situation of the instant report of the insured peasants'cross-provincial medical treatment in Beijing-Tianjin-Hebei region, and then analyze the main stakeholders involved in the process of the instant report, and explore the influence between the main stakeholders and the instant report of the insured peasants' cross-provincial medical treatment in Beijing-Tianjin-Hebei region, so as to make the cross-provincial medical treatment in Beijing-Tianjin- Research contents 1. Combine the related concepts, connotations, theories and research status at home and abroad, practical experience. 2. Analyze the policy system, information technology, business processes and settlement methods of the instant report of the insured peasants in Beijing-Tianjin-Hebei region, and summarize the main problems faced. Key issues. 3. Using stakeholder analysis method, this paper analyzes the correlation degree, willingness to implement and policy influence of the main stakeholders in the instant report of the insured peasants'cross-provincial medical treatment in Beijing-Tianjin-Hebei region. 4. Discusses the influence between the main stakeholders and the instant report of the insured peasants' cross-provincial medical treatment in Beijing-Tianjin-Hebei region. Data sources: (1) Literature research: Systematically combing the relevant theories and practices at home and abroad by searching and researching relevant literature materials in Chinese and foreign literature databases and government portals; (2) Field survey: through questionnaire survey and semi-structured interviews, Methods: (1) Stakeholder analysis: Determine the main stakeholders involved in the work of instant medical report of the insured peasants in Beijing-Tianjin-Hebei region, and use the analysis indicators, with the help of questionnaires and in-depth interviews, to understand the main stakeholders. Characteristics of stakeholders; (2) Expert consultation method: the design of questionnaires to identify stakeholders, identify major stakeholders and determine the stage of analysis indicators consultation experts and scholars; (3) Descriptive statistical analysis: questionnaire survey, in-depth interviews and expert consultation collected in qualitative, quantitative data using commonly used statistical methods Result 1. The basic situation and policy system of the instant medical report of the insured peasants in Beijing-Tianjin-Hebei region, the overall compensation policy and the reimbursement policy in Beijing-Tianjin-Hebei region are different, all of which emphasize the referral system. In the aspect of business process, Beijing-Tianjin-Hebei region has not carried out the real-time settlement test for the cross-provincial medical treatment report of the insured peasants. However, other areas have designed a "face-to-face" reporting model. The existing problems, Beijing-Tianjin-Hebei region in the implementation of immediate reporting work is faced with the low and different levels of urban and rural residents'medical insurance, the information construction of immediate reporting is uneven and the lack of systematic planning and other major issues. 2. Beijing-Tianjin-Hebei region insured farmers cross-province. Stakeholder analysis of medical immediate report in Beijing-Tianjin-Hebei region People's and social sectors have high degree of association, high policy influence and supportive attitude; health administrative departments have low degree of association, medium policy influence and supportive attitude; medical insurance agencies have high degree of association and higher political power. Policy influence and relatively supportive attitude; local medical institutions have high degree of association, higher policy influence and neutral attitude; medical institutions in the insured areas have low degree of association, lower policy influence and neutral attitude; farmers in the insured areas have high degree of association, lower policy influence, and are the biggest beneficiaries of support attitude. Conclusion 1. People's and social departments, medical insurance agencies and local medical institutions have a high degree of correlation with the work of immediate reporting in Beijing-Tianjin-Hebei region, and have a strong policy influence. It is necessary to strengthen the willingness of the three departments (institutions) to implement the work of immediate reporting in Beijing-Tianjin-Hebei region. For medical insurance agencies, it is necessary to mobilize the enthusiasm of staff and avoid the risk of medical insurance funds; for local medical institutions, it is necessary to ensure that the reimbursement fees of medical insurance are paid back within the prescribed time limit. The main stakeholders have an impact on the system planning, overall planning level and information construction of the cross-provincial medical report of the insured peasants in Beijing-Tianjin-Hebei region, while the cross-provincial medical report of the insured peasants in Beijing-Tianjin-Hebei region has brought about the problems of risk supervision and incentive and constraint for the main stakeholders. To coordinate the interests of the major stakeholders in the immediate report; 2. to gradually improve the overall level of the basic medical insurance system in Beijing-Tianjin-Hebei region; 3. to speed up the construction of information technology to lay a solid foundation for the immediate report of inter-provincial medical treatment; 4. to strengthen risk control and implement effective supervision; 5. to establish an assessment mechanism and incentive and restraint mechanism; 6. to establish a holistic view and pass System planning creates a system of synergy.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R197.1;F842.684;F323.89
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