上海基本医疗费用结构优化的对策研究

发布时间：2018-05-15 02:15

本文选题：上海 + 基本医疗费用　；参考：《上海工程技术大学》2014年硕士论文

【摘要】：近年来，世界各国都面临着医疗费用增长过快的压力，我国也不例外。尤其是上海，作为医疗中心城市之一，具有优质医疗资源密集、医疗服务需求旺盛和诊疗服务量大的突出特点，医疗费用控制难度相对较大。医疗费用的增长归根到底是社会经济发展的结果，经济的不断增长和社会结构的深入变化，会引致需求的改变，而这种改变集中表现在规模的增加和层次的分化，且伴随着制度的调整，这种改变会愈加明显。随着上海地方经济的高速增长、人口结构的急剧变化、医疗改革的稳步推进，上海医疗费用也跟着上涨。这不仅关系到每个民众的切身利益，还直接关系到经济、社会和全局的稳定。因此，我们极有必要研究上海医疗费用增长的深层次原因是什么，以及如何优化和调整上海医疗费用支出的结构。本研究目的在于实现对医疗费用结构定量的科学管理，，合理配置有限的医疗资源，减少医疗资源的浪费，最大发挥医疗服务的效益。本研究选用“政策制定科学程序”作为指导性研究方法，社会学调查方法、统计分析方法、经济学预算平衡分析作为应用性研究方法。通过文献归纳分析、二次资料利用和专家咨询论证来收集资料。本研究由五个部分构成：第一部分即第一章和第二章，介绍前言和理论基础。前言部分包括问题的提出，研究的背景、意义、目的和方法，以及文献综述等内容，并且通过比较研究，介绍国内外的做法和经验；理论基础部分包括相关概念界定、医疗服务特点及医院补偿机制等内容。第二部分即第三章，阐述如何发现问题。通过对卫生总费用和医疗费用增长情况的实证分析，发现医疗费用管理中最突出的问题是费用的结构化问题。第三部分即第四章和第五章，阐述如何分析问题。首先，结合数据，对上海基本医疗费用结构进行定量分析；其次，在预算平衡下，对医疗费用结构调整进行可行性论证。第四部分即第六章，阐述如何解决问题。通过建立科学合理的度量标准，对医疗费用结构进行定量优化。第五部分即第七章，进行研究总结与展望。本研究得到的结果和结论即药品费用比重居高不下、检查费比率上升过快、护理费等医疗服务费用所占份额相对偏低，公立医疗机构补偿机制缺陷、医疗机构宏观导向有偏差，医疗费用结构比例失衡、医疗费用结构优化度量标准缺失。本研究的创新之处是确立了医疗费用管理的基本政策思路，即“总量适宜，结构优化，分担合理”。在此基础上，建立了医疗费用结构优化的度量标准，科学、合理、有效地控制医疗费用过快增长，同时保证医院补偿机制向良性循环。
[Abstract]:In recent years, countries all over the world are facing the pressure of rapid growth of medical expenses, China is no exception. Especially Shanghai, as one of the medical center cities, has the prominent characteristics of high quality medical resources, strong demand for medical services and large amount of diagnostic and therapeutic services, and it is relatively difficult to control medical expenses. In the final analysis, the increase in medical expenses is the result of social and economic development. The continuous growth of the economy and the profound changes in the social structure will lead to changes in demand, and this change is concentrated in the increase of scale and the division of levels. And with the adjustment of the system, this change will become more obvious. With the rapid growth of Shanghai's local economy, the rapid change of population structure and the steady progress of medical reform, the medical expenses in Shanghai have also risen. This concerns not only the vital interests of everyone, but also economic, social and overall stability. Therefore, it is necessary for us to study the deep-seated reasons for the increase of medical expenses in Shanghai, and how to optimize and adjust the structure of medical expenditure in Shanghai. The purpose of this study is to realize the scientific management of the structure of medical expenses rationally allocate the limited medical resources reduce the waste of medical resources and maximize the benefits of medical services. In this study, "policy making scientific procedure" is chosen as the guiding research method, the sociological investigation method, the statistical analysis method, and the economic budget balance analysis as the applied research method. Through literature analysis, secondary data use and expert consultation to collect information. This study consists of five parts: The first part is the first chapter and the second chapter, introduces the preface and the theoretical basis. The foreword includes the questions, the background, the significance, the purpose and the method of the research, and the literature review, and introduces the domestic and foreign practices and experiences through the comparative study, while the theoretical basis includes the definition of the relevant concepts. Medical service characteristics and hospital compensation mechanism. The second part is the third chapter, expounding how to discover the problem. Through the empirical analysis of the total health expenditure and the increase of the medical cost, it is found that the most prominent problem in the management of medical expenses is the structural problem of the cost. The third part is the fourth and fifth chapters, how to analyze the problem. First of all, combining with the data, the structure of basic medical expenses in Shanghai is analyzed quantitatively; secondly, under the budget balance, the feasibility of adjusting the structure of medical expenses is demonstrated. The fourth part, the sixth chapter, expounds how to solve the problem. By establishing scientific and reasonable measurement standards, the structure of medical expenses is quantitatively optimized. The fifth part, the seventh chapter, carries on the research summary and the prospect. The results and conclusions of this study are as follows: the proportion of drug cost is high, the ratio of examination fee is rising too fast, the share of medical service cost such as nursing fee is relatively low, the compensation mechanism of public medical institution is defective, and the macro orientation of medical institution has deviation. The ratio of medical expense structure is out of balance and the measure of medical expense structure optimization is missing. The innovation of this study is to establish the basic policy thinking of medical cost management, that is, "the total amount is appropriate, the structure is optimized, and the sharing is reasonable". On this basis, a scientific, reasonable and effective measure of optimizing the structure of medical expenses is established to control the excessive growth of medical expenses, and to ensure that the compensation mechanism of the hospital is in a virtuous circle at the same time.
【学位授予单位】：上海工程技术大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684

【参考文献】