【作者】 刘永强；

【导师】 尹爱田；

【作者基本信息】 山东大学 ， 社会医学与卫生事业管理， 2007， 硕士

【摘要】 近年来，医疗费用不断上涨，“看病难、看病贵”问题日益成为社会各界和人民群众普遍关注的热点问题，也是困扰医疗卫生事业发展的一个重大难题。为解决这一问题，山东省把控制医药费用过快增长、减轻群众医疗负担作为一项重要任务来抓，采取了多项措施综合整治，如开展医疗质量管理效益年工作、实行药品和医用耗材招标采购、加强医疗机构经济管理等。以上举措的实施，取得了一定的成效，医疗费用过快增长的趋势有所缓解。尽管如此，“看病难、看病贵”的问题并未解决，医药费用与群众支付能力之间的矛盾仍然十分突出。科学分析“看病难，看病贵”成因，破除体制、机制性障碍，建立与社会主义卫生事业性质和市场机制相适应的行业自律和监管机制，增强医疗机构降低服务成本、控制医药费用的责任意识和自觉性，是破解医疗体制改革的必然选择。传统的医疗服务项目收费制度，容易造成过度医疗、医护人员行为失范，加重患者经济负担，造成医疗资源的浪费和滥用。实行单病种限价，能够克服传统项目的弊端，防止过度诊疗行为，降低医疗费用；可以减轻群众的医疗费用负担；此外，医药费用降低的同时又会拉动医疗需求，有利于形成降低病人费用与促进医院健康发展有机统一的运行模式。作为规范医疗行为、提高医疗质量和降低医疗费用的重要手段，单病种限价收费在我省部分二、三级医院也进行了积极试点。但由于单病种限价尚处于起步阶段，其具体实施效果也有待于进一步的探讨和考证。基于上述诸多问题的存在，本研究的主要目的是在系统分析的基础上明确：我省单病种费用限价的基本情况?我省单病种限价的经验，政策推广的作用和效果?针对单病种限价存在的问题，今后该如何进一步规范和完善?本研究通过查阅国内外文献资料，借助山东省信息统计中心相关单病种资料，结合知情者访谈，并在重点分析济宁医学院案例的基础上，对我省的单病种限价收费情况进行定性、定量分析和论证。研究的主要结果：通过在全省初步推广单病种限价收费工作，降低了医疗成本，减轻了患者负担；规范了诊疗行为，提高了医疗质量；改善了医患关系，端正了行业作风；实施了目标管理，促进了医院发展。研究认为，我省实施单病种限价付费也是处于一个尝试、探索的阶段，难免存在一些不足，如病种不统一、不规范；覆盖面窄，受益群体有限；医疗机构费用测算方法不科学；部分医疗机构缺乏有效管理等。因此，需要我们进一步深入研究和规范完善。政策建议：单病种限价需要同步建立相关保证制度；完善相关质量监管制度；逐步规范单病种费用支付制度；强化政府责任，妥善处理各方利益关系；与其他支付方式混合运用以达到预期良好效果。更多还原

【Abstract】 In recent years, the health expenditure has been increasing in China. As a result, "too difficult and too expensive to see a doctor" has become a hot topic of the society, and it is also one of the difficulties that baffled the development of health care.In order to solve the problem, our provincial government takes the controlling increase of medical expense and reducing people’s economic burden as a task. And many measures have been taken, such as developing the quality management year of medical institutions, classified management of medical institutions, Pharmaceuticals procurement via tender bidding, separation of drug prescribing and dispensing and reinforcing the economic management of medical institution, etc. Though the measures are effective, and have achieved certain effects to some extent. The problem of "too difficult and too expensive to see a doctor" has not been solved.The traditional fee for service has not met the demand of society owing to its disadvantages. As an effective way standardizing medical behavior and improving medical quality, limited price charge for single disease has been made experiment by many hospitals of different level. And as a new thing, the real effect of it needs long term monitor.The study applies literature home and abroad, mailing survey, key-informant interview interrelated information from statistical Center of Shandong province and document review to collect quantitative and qualitative data. Besides, the study uses the example of the hospital attached to Jining Medical College, aiming to answer the following questions: what’s the basic situations of the limited price for single disease in Shandong province? What is the effect of it and what lessons can we draw? And how to put forward some strategic suggestions and advices?The study has following major findings. The effect of the limited price charge for single disease in Shandong is obvious. Namely, the medical cost has been reduced, and the burden of patients has been lightened; The behavior of diagnosis and treatment has been normalized, and the medical quality has been improved; The relationship between doctors and patients has been improved, and the professional style has been corrected; The hospitals get development as a result of the performance management, etc. On the other hand, though the limited price charge for single disease now is effective, there are still many problems and it needs further perfect, such as, the names of disease are nonstandard and there are not standardization diagnosis and treatment; the scope of single-disease is relatively narrow; the method of accounting the cost of disease is not scientific, the same disease charges differently in hospitals of different level and in different places, the medical institutions are lack of effective management, and so on.Five main policy suggestions are raised. Firstly, set up interrelated guarantee system synchronously; Secondly, strengthen the supervision and management of medical quality; Thirdly, standardize the scheme of limited price charge for single-diseases; Fourthly, intensify the governmental responsibility by the related sectors cooperating; Finally, the scheme of limited price charge for single disease can attain good effect with the help of other paying ways.更多还原