成都市医保付费总额控制的现状、问题及对策研究

发布时间：2018-03-10 04:01

本文选题：成都市　切入点：医疗保险　出处：《西南财经大学》2014年硕士论文　论文类型：学位论文

【摘要】：近年来,全国上下大力推进基本医疗全覆盖工作,医保待遇逐年提高,我国各大城市医保基金的支出呈连年上升趋势,同时,人口老龄化的不断加剧也对医保基金的收入和支出也带来了巨大的影响。随着人们生活水平的提高,健康意识的加强,对医疗服务的需求也迅速增长,这与有限的医疗资源的供应形成了一对矛盾。目前,全国医保基金尚能基本保持收支平衡,但随着人口老龄化的加剧,医疗服务需求增长的趋势难以改变,医保基金要继续保持收支平衡,必须采取有效的支出控制政策。国家人社部等三部委于2012年底颁布了《关于开展基本医疗保险付费总额控制的意见》。文件指出,我国医保工作的基本制度已建立,政策上正逐步实现全覆盖,参保人数连年增加,下一阶段的工作重点是要按照国务院“新医改”方案的指导思想,转向提升保障水平和改革医保付费方式。随着医保基金预决算工作的开展,对医保付费方式的改革要和医保基金的预算相结合,并在全国范围内开展基本医疗保险付费总额控制工作,以保证医保基金健康持续的运行。医保付费总额控制工作的开展势在必行。总额控制对控制医疗保险基金支出起到积极作用,但如何在控制医疗费用增长的同时,保障参保人员权益、规范医疗服务行为和促进医疗机构发展?作为对医保费用控制手段的总额控制政策,如何与几种常用的医保付费方式相结合才能发挥效用最大化?成都市从2013年6月开始正式实施医保付费总额控制,开展该项工作大半年以来,在实际操作中遇到一些问题,政策制定相关部门及时调整了具体的实施细则,以求更好的落实医保付费总额控制,提高医保基金的使用效率。由于是政策实施的第一年,尚处在探索中逐步完善的阶段,目前正在实施的医保付费总额控制政策有何不足,能否有更优化的措施? 本文拟通过对医保付费总额控制政策制定的研究,对几种常用的医保付费方式的分析,结合成都市医保付费现状,探讨成都市目前正在实施的医保付费总额控制政策中存在的问题,并尝试提出优化措施。
[Abstract]:In recent years, the country vigorously promote the full coverage of basic medical and health insurance benefits increased year by year, China's major city health insurance fund expenditures showing an upward trend year after year, at the same time, the growing aging population of health insurance fund income and expenditure has also brought huge impact. With the improvement of living standards, the strengthening of health awareness, the demand for medical services is also growing rapidly, and the limited supply of medical resources to form a pair of contradictions. At present, the national health insurance fund is to maintain the balance of payments, but with the aging of the population increase, the demand for medical services and the growth trend is difficult to change, the health insurance fund to continue to maintain the balance of payments balance, we must take effective expenditure control policy.
The State Department and other three ministries issued "on the basic medical insurance to pay the total control opinions. Document pointed out that at the end of 2012, the basic medical insurance system in China has been established, the policy is gradually achieve full coverage, the number of insurance has increased year by year, the focus of the next phase is to follow the guiding ideology of the new State Council" health care plan, to improve the level of protection and the reform of Medicare payment. With the medical insurance fund budget to carry out the work of the Medicare payment reform and medical insurance fund budget combination, and carry out the basic medical insurance to pay the total control work in the country, in order to ensure sustained and healthy operation of medical insurance fund.
Medicare to pay the total control work is imperative. The total positive effect on the control of medical insurance fund expenditures, but how to control the growth of medical expenses at the same time, to protect the interests of the insured, standardize the medical service and promote the development of medical institutions? As to the total amount of medical insurance cost control means the control policy, and how some common medical insurance the combination of pay to play the maximum utility? Chengdu city began the formal implementation of Medicare to pay the total control from June 2013, since the work for half a year, some of the problems encountered in the actual operation, policy relevant departments timely adjustment of the specific implementation details, in order to better implement the Medicare to pay the total control, improve the efficiency of the use of medical insurance fund. As the first year of the implementation of the policy is still in the stage of exploration and gradually improve, is currently in the implementation of the medicine What is the shortage of the total amount of payment control policy, and can there be more optimized measures?
This paper through the research on the policy formulation of Medicare to pay the total control of several commonly used Medicare payment methods to analysis, combined with the Chengdu City medical insurance payment status of Chengdu City, is currently being implemented in the medical insurance payment policy problems in total control, and tries to put forward the optimization measures.

【学位授予单位】：西南财经大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R197.1;F842.684

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