發(fā)布時(shí)間：2018-12-29 09:24

【摘要】：醫(yī)療費(fèi)用的過快增長一直是制約我國衛(wèi)生事業(yè)發(fā)展的因素之一,為此,深化醫(yī)藥衛(wèi)生體制改革是大勢(shì)所趨,改革的內(nèi)容涉及多個(gè)方面,其中,對(duì)于醫(yī)療保險(xiǎn)支付方式的改革是當(dāng)中的重點(diǎn)和難點(diǎn)�？v觀改革大勢(shì),各地對(duì)醫(yī)療保險(xiǎn)支付方式的改革呈現(xiàn)出多樣化。長沙市自2000年建立城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)制度以來,對(duì)于醫(yī)療保險(xiǎn)支付方式的改革也在探索中前進(jìn),長沙市在醫(yī)療保險(xiǎn)支付方式改革進(jìn)程中取得了哪些成果?又存在哪些問題?如何突破現(xiàn)有的制度困境?這些問題都很值得研究,也具有一定的現(xiàn)實(shí)意義。本文就是以長沙市醫(yī)療保險(xiǎn)支付方式改革作為切入點(diǎn),具體探討長沙市在醫(yī)療保險(xiǎn)支付方式改革進(jìn)程中取得的成效和存在的問題,在此基礎(chǔ)上對(duì)長沙市支付方式未來的改革方向進(jìn)行構(gòu)建。 本文在對(duì)國內(nèi)外文獻(xiàn)進(jìn)行深入研究的基礎(chǔ)上,首先,對(duì)各種常見支付方式進(jìn)行經(jīng)濟(jì)學(xué)分析,基于委托-代理理論提出預(yù)付制才是改革的正確方向；其次,基于對(duì)長沙市醫(yī)療保險(xiǎn)事業(yè)發(fā)展的準(zhǔn)確把握,具體分析長沙市醫(yī)療保險(xiǎn)支付方式在改革進(jìn)程中取得的成效和存在的問題；而后,通過借鑒國外典型國家和我國典型地區(qū)的醫(yī)療保險(xiǎn)支付方式改革的經(jīng)驗(yàn),在此基礎(chǔ)上,提出長沙市醫(yī)療保險(xiǎn)混合支付方式的構(gòu)建思路。研究的主要結(jié)論如下： 1.長沙市在醫(yī)療保險(xiǎn)支付方式改革過程中,取得的成效包括：醫(yī)療保險(xiǎn)統(tǒng)籌基金運(yùn)行平穩(wěn),醫(yī)療費(fèi)用個(gè)人負(fù)擔(dān)的比例有所下降,醫(yī)生負(fù)擔(dān)病人情況逐步降低,同時(shí)采取按單病種付費(fèi)之后,次均費(fèi)用和住院天數(shù)均有所下降。 2.長沙市在醫(yī)療保險(xiǎn)支付方式改革進(jìn)程中,存在的問題包括：統(tǒng)籌基金支出的增長率高于收入增長率,單病種付費(fèi)所占比例過小,在醫(yī)療費(fèi)用中藥品費(fèi)用所占比重過高,同時(shí)基層醫(yī)療機(jī)構(gòu)的作用未充分體現(xiàn)。 3.長沙市醫(yī)療保險(xiǎn)混合支付方式的構(gòu)建：推行總額預(yù)付,繼續(xù)擴(kuò)大按單病種付費(fèi),實(shí)行基本藥物目錄零差率銷售制度三個(gè)方面。
[Abstract]:The excessive growth of medical expenses has always been one of the factors restricting the development of health care in China. Therefore, deepening the reform of the medical and health system is the trend of the times. The content of the reform involves many aspects, among which, The reform of medical insurance payment is the key and difficult point. Throughout the general trend of reform, all over the medical insurance payment mode of reform presents diversification. Since the establishment of the basic medical insurance system for urban workers in Changsha in 2000, the reform of the payment mode of medical insurance is also in the process of exploration. What achievements have been made in the reform of the medical insurance payment mode in Changsha? What are the problems? How to break through the existing system dilemma? These problems are very worthy of study, but also have certain practical significance. This paper, taking the reform of medical insurance payment mode in Changsha as the starting point, specifically discusses the achievements and existing problems in the process of medical insurance payment reform in Changsha. On the basis of this, the future reform direction of payment mode in Changsha is constructed. Based on the in-depth study of domestic and foreign literature, this paper first of all, the economic analysis of a variety of common payment methods, based on the principal-agent theory is the correct direction of the reform of the prepayment system; Secondly, based on the accurate understanding of the development of medical insurance in Changsha, the paper analyzes the effect and problems of the medical insurance payment in Changsha. Then, based on the experience of medical insurance payment reform in typical countries and regions of China, this paper puts forward the construction idea of mixed payment mode of medical insurance in Changsha. The main conclusions are as follows: 1. In the course of the reform of the medical insurance payment system in Changsha City, the results have included: the smooth operation of the medical insurance overall planning fund, the decrease in the proportion of individual burdens for medical expenses, and the gradual decrease in the burden on patients by doctors. At the same time, the average fee and the number of days in hospital decreased after the single-disease payment. 2. In the process of medical insurance payment reform in Changsha, the existing problems include: the growth rate of overall fund expenditure is higher than the income growth rate, the proportion of single-disease payment is too small, and the proportion of drug expenditure in medical expenses is too high. At the same time, the role of primary medical institutions is not fully reflected. 3. The construction of mixed payment method of medical insurance in Changsha city: carry out total advance, continue to expand the payment by single disease, and implement the zero difference sales system of essential drugs catalogue.
【學(xué)位授予單位】：湖南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：F842.684

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