黑龙江省医疗保险结算模式与费用控制分析

【作者】 李晓光；

【导师】 刘丽伟；

【作者基本信息】 黑龙江大学 ， 公共管理， 2010， 硕士

【摘要】 医疗保险结算模式多种多样,不同的医疗保险结算模式对医疗保险机构、医疗服务供方和需求方的影响各不相同。科学合理的结算模式可以规范和引导供方的医疗行为,使医疗费用的发生趋于合理化,并在费用控制、卫生资源配置、医疗质量等方面呈现出明显的正面影响。在现阶段,某种单一的结算模式不可能完美地决医疗费用控制的所有问题。但是,单一结算模式的缺陷可以通过其他措施进行一定程度的弥补。发达国家医疗保险的经验和教训表明,医疗保险结算模式的创新和完善是控制医疗费用最主要的、最有效的办法。因此,改革现有的结算模式,完善各项法律法规和操作规范,已经成为各地控制医疗费用,提高医疗保险基金使用效率的重要途径。本文通过对黑龙江省哈尔滨、牡丹江和佳木斯市不同结算模式对医疗费用控制的比较分析,研究现行的结算模式对供需双方医疗行为的影响,提出了复合式结算模式及医疗费用合理控制可行性建议。更多还原

【Abstract】 Many models of medical insurance billing, medical insurance settlement for different medical insurance institutions, medical services, supply-side and demand-side effects are different. Scientific and reasonable settlement for parties to regulate and guide for the medical act, the occurrence of medical cost rationalization and cost control, health resources, health care quality has shown a significant positive impact. At this stage, a single settlement for medical expenses must not perfectly control all the problems. However, defects in a single settlement for other measures can be offset to some extent the. Developed countries, health insurance experience and lessons that medical insurance billing model innovation and improve the control of major medical expenses, the most effective approach. Therefore, the reform of the existing settlement pattern, perfect operation of the laws, regulations and norms, has become over control medical costs and increase efficiency in the use of medical insurance fund important way. Based on the Heilongjiang Province, Harbin, Mudanjiang and Jiamusi City medical costs of different settlement patterns on the control of a comparative analysis, Of the existing settlement patterns on both supply and demand of medical behavior, presented a composite settlement patterns and the feasibility of the proposed reasonable control medical costs.更多还原