【作者】 王婷；

【导师】 吴奇飞；

【作者基本信息】 华中科技大学 ， 社会医学与卫生事业管理， 2017， 硕士

【摘要】 【目的】了解湖北省支付方式改革进展基本情况,对其中的总额预付制进行深入研究,研究涉及镇村两级门诊总额预付制、乡镇卫生院和县级医疗机构住院总额预付制。主要研究总额预付制政策设计情况、政策运行情况、取得的成效和存在的问题及问题产生的深层次原因,以对湖北省总额预付制开展以来的实际情况做一个正确的评估和总结,并为下一步总额预付制在全省范围内推广奠定基础。【方法】本文主要采取文献梳理法和质性研究法。对国内外有关总额预付制和支付方式改革的相关文献进行梳理分析;收集11个试点县的支付方式改革政策,梳理出湖北省支付方式改革进展基本情况;对其中5个试点地区总额预付制的相关政策分析研读,在此基础上制定出访谈的提纲,对这5个地区的合管办、人民医院和乡镇卫生院相关人员进行实地访谈。【结果】11个地区均进行了支付方式改革的探索,各地门诊基金主要采取总额预付制,住院基金主要采取以总额预付制为主的混合式付费模式,且各地均在总额预付制的基础上制定了配套的管理控制措施,并借助分级诊疗来配合支付方式改革的开展。对其中5个地区总额预付制实施情况的实地调查发现,总额预付制改革取得了初步的成效,各地都进行了不同程度的探索,并加强了管理能力建设,完善了反应型监管模式,加强了信息化建设,经办机构与定点医疗机构间建立起内部合作。但是不管是门诊总额预付还是住院总额预付,都还存在一定的问题和障碍。对问题产生的原因进行深入分析发现,各方对总额预付制改革的认知影响其推进速度,目前简单的、粗放的总额预付在一定程度上阻碍了支付方式改革的推进,外部环境也有一定的影响,付费标准的测算、谈判机制的缺失、以及约束机制和激励机制不对等都影响到总额预付制改革的实施效果。【结论】总额预付制是现阶段遏制医疗费用过快增长的比较有效的方式,但是总额预付制绝不是简单的支付方式的转变,必须在老百姓一定的满意度、医疗机构得到正常发展和新农合基金可承受三者之间取得平衡,总额预付制改革才能顺利推行下去。更多还原

【Abstract】 [Purpose] Understand the basic situation of the progress of payment reform in Hubei Province,and carry out an in-depth study of the total prepayment system.The study involves the county and village level outpatient total prepaid system,and township hospitals and county-level medical institutions in the total hospital advance payment system.Mainly to study the total amount of pre-paid policy design,policy operation,the achievements and the existing problems,then get a correct assessment and summary,and lay the foundation for the promotion of the next total amount of prepayment in the province.[Methods] This article mainly adopts the literature combing method and the empirical research method.This paper analyzes the relevant literatures on the total amount of prepayment and payment reform at home and abroad;collecting the policy of 11 pilot counties;sort out the basic situation of the progress of payment reform in Hubei Province;analysis the five pilot areas of the total amount of pre-paid system-related policies and develop an outline of the interview;then interviews with relevant personnel in the pilot area.[Results] Since the start of payment reform in Hubei Province in 2012,many places have implemented payment reform.Local outpatient funds mainly take the total amount of prepaid system,and inpatient funds mainly take the total amount of prepaid system based on the hybrid payment model.The pilot area has the most exploration of the total prepayment system,developed a more comprehensive policy.The total prepaid system in the pilot area has achieved initial results,strengthen management capacity building,play an important role in ensure the safety of the Fund.The total prepaid system reform also faces some problems and challenges,propulsion is slow,the parties lack of knowledge,the implementation of the way is more extensive.[Conclusions] Total prepaid is a more effective way to curb the rapid growth of medical expenses at this stage,but the total prepaid system is by no means a simple way of payment changes.Total prepaid must balance the people’s satisfaction,the normal development of medical institutions and the fund.更多还原