摘要
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。
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.
出处
《中国医院》
2013年第9期I0002-I0002,1-3,共4页
Chinese Hospitals
基金
IMS中国医疗健康信息学院"卫生服务研究网络"资助项目
2012年度上海市卫生局局级科研项目"上海市实施医保总额预付制对三级医院的影响评估"(20124422)
关键词
医疗保险
总额预付
三级医院
medical insurance,global budget,tertiary hospitals
