【作者】 李林；

【导师】 代先华；

【作者基本信息】 华中师范大学 ， 公共管理（专业学位）， 2018， 硕士

【摘要】 研究主题与背景:自1984年卫生部和财政部联合发出《关于进一步加强公费医疗管理的通知》开始,我国对医疗改革已经进行了三十多年的探索。这三十多年来,我国分别开辟了城镇基本医疗保险制度以及新农村合作医疗制度两种改革道路,取得了辉煌的成就。但是这三十多年来也是我国经济腾飞的三十年,也是“先富一部分人,先富帮后富”理念践行发展的关键时期,我国东西部经济发展出现严重分化,西部地区经济相对落后,尤其是西部五省包括陕西省,甘肃省,青海省,新疆维吾尔自治区,宁夏回族自治区。地区医疗水平与医疗资源分配也是与地区经济发展密切相关,因此西部贫困地区医疗改革出现了与大的方向政策的不适应性。由于政府对公立医院投入不足、补偿机制不合理与监管不力等问题突出,西部五省地区的公立医院作为服务大众的公益性质逐渐淡化,不同程度的逐利行为开始凸显,“看病难,看病贵”的问题愈发突出。因此我们有必要研究现阶段我国西部五省地区公立医院补偿机制在医疗改革方向下的管控成效,发现公立医院补偿机制面临的矛盾与问题。研究思路:本论文主要通过对西部五省的医疗状况作出系统数据分析,并着重对宁夏地区公立医院医疗费用的结构性增长与财政补助以及监管政策的分析,研究如何通过政策管控手段保障公共医疗资源合理利用,控制医疗费用上涨,降低百姓医疗负担,运用多种分析方式分析我国现阶段西部五省医疗补偿机制的管控成效。通过对比其他国家的医疗体系的市场化改革方案与政策引导方法,归纳总结并提炼经验教训,为新一轮的医疗补偿机制改革中的医疗费用管控提供一些建议和思考。研究方法:本文首先介绍了研究的背景和理论基础,并分析了我国医疗改革政策不同的历史阶段,通过对医疗费用的结构性分析,为后续的医疗改革方案与医疗服务管控手段的成效评价提供数据支持。对西部五省的医疗资源,财政支持与监管政策作出具体分析,并对宁夏贫困地区公立医院的运营情况,政府补助情况以及医疗保障制度建设情况的数据进行分析,分析我国医疗改革补偿机制下西部五省地区公立医院实际运行情况以及相关管控政策的实效性与不足,对医疗费用与政府补偿的进行具体分析,提出相对应的解决方案和意见。最后对我国医疗补偿机制改革下西部五省地区公立医院对应的相关政策的发展方向进行归纳总结与展望,期望能够提出新的改革具体方案。研究结论:是在医疗体制改革下西部五省地区公立医院补偿机制由于出现了政府补偿不足,资金监管不到位,补助标准混乱等诸多问题导致这些地区医疗依旧存在“看病贵”“看病难”等问题。因此为了更好的践行落实医疗补偿政策,解决群众关心的看病问题,政府应该保障财政投入,不断完善医疗服务价格体系,健全医疗保险服务体系,建立多元化医疗保险格局,推进药品生产流通体制改革等,来降低百姓医疗负担,推动医疗服务市场合理健康发展。更多还原

【Abstract】 Research theme and background:Since 1984,when the Ministry of Health and the Ministry of Finance jointly issued A Notice on Further Strengthening the Management of Public Health Care,China has been exploring the reform of medical treatment for more than 30 years.In the past thirty years,China has opened up two kinds of reform roads,namely,the basic medical insurance system in cities and towns and the new rural cooperative medical insurance system,and has made brilliant achievements.These more than 30 years have been three decades of rapid economic development in our country,and are also the key period for the implementation and development of the concept of"getting rich first and then helping others to become rich".The economic development of the eastern and western regions of China has been seriously divided.The western region is relatively backward,especially the five western provinces,including Shaanxi,Gansu,Qinghai,Xinjiang Uygur Autonomous region and Ningxia Hui Autonomous region.The level of regional medical treatment and the distribution of medical resources are also closely related to their economic development.Therefore,the western poor area medical reform appeared with the big direction policy inadaptability.Due to insufficient government investment in public hospitals,unreasonable compensation mechanisms,inadequate supervision and other problems,the public hospitals in the five provinces of the West are gradually playing down the commonweal nature of serving the public,and the profit-driven behavior of different degrees is beginning to be highlighted.The problem of "Difficult and expensive to see the doctor" has become increasingly prominent.Therefore,it is necessary for us to study the effectiveness of the compensation mechanism of public hospitals in the five provinces of western China under the direction of medical reform at the present stage,so as to find out the contradictions and problems faced by the compensation mechanism of public hospitalsResearch ideas:This paper mainly analyzes the medical status of five western provinces,and focuses on the analysis of the structural growth of medical expenditure and the financial subsidy and supervision policy of public hospitals in Ningxia.This paper studies how to ensure the rational use of public medical resources through the means of policy control,control the rise of medical expenses and reduce the medical burden of the common people,and analyze the effectiveness of the medical compensation mechanism of the five western provinces in China at this stage by using various analytical methods.By comparing the market-oriented reform and policy guidance of medical system in other countries,this paper sums up and abstracts the experience and lessons,and provides some suggestions and thoughts for the new round of medical compensation mechanism reform.Research conclusions:Under the reform of the medical system,the compensation mechanism of public hospitals in the western five provinces and regions is not in place due to insufficient government compensation and inadequate supervision of funds.The confusion of subsidy standards leads to the problems of "expensive" and "difficult"medical treatment in these areas.Therefore,in order to better adjust and implement the medical compensation mechanism to solve the problem of medical treatment among the people,the government should ensure financial input,perfect the price system of medical services,the medical insurance service system,and establish a diversified pattern of medical insurance.Promoting the reform of drug production and circulation system to reduce the people’s medical burden and promote the rational and healthy development of the medical market.更多还原