上海市实施医保总额预付制对三级医院的影响研究
상해시실시의보총액예부제대삼급의원적영향연구
Research on the effect of global budgeting in social health insurance towards the tertiary hospitals in Shanghai
  • 万方数据
    中国医院 중국의원
    CHINESE HOSPITALS
    2013年 9期 1-3 ,共3页

    于广军%赵蓉%郑培永%杨丽%杜宁%黄玲萍%厉传琳%杨中浩%刘宝%应晓华%杨虹宇%何萍%杨佳泓

    우엄군%조용%정배영%양려%두저%황령평%려전림%양중호%류보%응효화%양홍우%하평%양가홍

    医疗保险%总额预付%三级医院 醫療保險%總額預付%三級醫院
    의료보험%총액예부%삼급의원
    medical insurance%global budget%tertiary hospitals
    　　目的：评估实施医保总额预付制对于三级医院的影响，并提出相应建议。方法：通过定性访谈、问卷调查、上海医联平台数据统计等收集资料，进行统计分析和理论分析。结果：医院调整发展战略，积极争取医保额度并争取外地患者增长，院内采取多种管理措施控制医疗费用的增长。大多数临床医师会调整对于医保患者的医疗行为，医院医保费用增长得到控制，医保患者药品费用结构发生改变。医保患者和非医保患者在就医感受上存在一定差异。医院收入结构发生变化，自费比重普遍上升。结论：实施医保总额预付制的政策效果已经初显，既有积极因素也有消极因素；同时，三级医院还受到其他非经济因素的影响。建议积极探索区域性医保预付制度，完善总额测算模型，制定相对合理的医保额度，并引导和鼓励三级医院加强医保管理。
    　　목적：평고실시의보총액예부제대우삼급의원적영향，병제출상응건의。방법：통과정성방담、문권조사、상해의련평태수거통계등수집자료，진행통계분석화이론분석。결과：의원조정발전전략，적겁쟁취의보액도병쟁취외지환자증장，원내채취다충관리조시공제의료비용적증장。대다수림상의사회조정대우의보환자적의료행위，의원의보비용증장득도공제，의보환자약품비용결구발생개변。의보환자화비의보환자재취의감수상존재일정차이。의원수입결구발생변화，자비비중보편상승。결론：실시의보총액예부제적정책효과이경초현，기유적겁인소야유소겁인소；동시，삼급의원환수도기타비경제인소적영향。건의적겁탐색구역성의보예부제도，완선총액측산모형，제정상대합리적의보액도，병인도화고려삼급의원가강의보관리。
    Objectives:To evaluate the effect of the Global budgeting towards the tertiary hospitals and provide some suggestion. Methods:Data collection through qualitative interviews, questionnaire survey and database statistics, and statistical and theoretical methodology was used in data analysis. Results:The hospitals adjusted their strategies of development, communicated for more medical insurance amount, broadened the range of patients from other province and took various effective measures to control medical expenses of growth. Most clinicians felt the health services for the insured patients were affected. Statistics show that the medical expenses growth was under control and the structures of the insured patients’ drug fee were changed. There are also some different perceptions between insured patients and uninsured patients. Hospitals’ economic structure has changed and the patient self-payment proportion of health expenditure in hospital has risen. Conclusion:Global budgeting has positive effects and negative effects. In addition, the tertiary hospitals were also affected by other non-economic factors. Our policy recommendation is that exploring the regional Global budgeting of hospital Groups instead of each hospital,improving the Global budgeting model for more reasonable budgeting, encouraging tertiary hospitals to strengthen the management of healthcare expenditure.
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