【作者】 黄俊；

【导师】 周美多； 杨胜余；

【作者基本信息】 电子科技大学 ， 公共管理硕士（专业学位）， 2023， 硕士

【摘要】 基本医疗保险(以下简称医疗保险)支付制度,是医疗保障制度的重要组成部分,其是否科学有效,事关医疗保障体系能否持续健康发展。2018年以来,伴随着国家医疗保障局的成立,医疗保险支付方式改革虽不断深入,但群众日益增长的医疗需求和医疗服务供给之间的不平衡以及医疗保险基金年年收不抵支的问题逐渐凸显,群众对医疗保险的满意度和参与度呈下降趋势。医疗保险支付方式改革作为减轻医疗保险基金压力、优化医疗服务、缓和医患关系的主要手段,对于提升群众的满意度和参与度有着非常重要的作用,可以有效提升当地的医疗保障水平,营造良好的医疗环境,推动社会健康发展。以彭州市医疗保险支付方式改革实施中存在的问题作为研究对象,依据新公共服务理论、利益相关者理论、需求与供给理论,并结合“霍恩-米特”政策执行系统模型的六个要素构建分析框架,从彭州市医疗保险支付方式改革的现状出发,运用文献分析、数据分析和问卷调查,分析存在的问题及成因,探索适合彭州市医疗保险支付方式改革的对策建议。经过调查研究发现,当前彭州市医疗保险支付方式改革存在医疗保险基金控费效果不明显、政策落实程度不高、执行资源不充足、政策法规不完善等问题。在此基础上,从政策目标与标准、政策资源和系统环境、组织沟通和执行方式、执行机构特征和执行者价值取向四个维度深入分析原因,最后围绕提升彭州市医疗保险支付方式改革质效这一目标,提出增强支付方式改革对医疗机构的激励效益、优化支付方式改革实施环境、提高支付方式改革的执行效率、健全医疗体系组织结构等可行性建议,以此提高医疗服务质量和群众的满意度,并对建立管用高效的医疗保险支付方式提供借鉴参考。更多还原

【Abstract】 The basic medical insurance(hereinafter referred to as medical insurance)payment system is an important part of the medical security system,and whether it is scientific and effective is related to the sustainable and healthy development of the medical security system.Since 2018,along with the establishment of the National Medical Security Administration,although the reform of the medical insurance payment method has continued to deepen,the imbalance between the growing medical needs of the masses and the supply of medical services and the imbalance between the medical insurance fund and the yearly income of the medical insurance fund The problem of the growing demand for medical services and the imbalance between the supply of medical services and the inability of the medical insurance fund to cover its expenses has gradually come to the fore.As the main means to reduce the pressure of medical insurance fund,optimize medical services and ease the relationship between doctors and patients,the reform of medical insurance payment method plays a very important role in enhancing the satisfaction and participation of the public,which can effectively improve the level of local medical security,create a good medical environment and promote the healthy development of society.Based on the new public service theory,stakeholder theory,demand and supply theory,and the six elements of the Horn-Meter policy implementation system model,we construct an analytical framework based on the current situation of Pengzhou’s health insurance payment reform.We use literature analysis,data analysis and questionnaire survey to analyze the problems and causes,and explore the countermeasures and suggestions suitable for the reform of medical insurance payment in Pengzhou.After investigation and research,it is found that the current health insurance payment reform in Pengzhou City has problems such as the lack of obvious effect of health insurance fund cost control,the low degree of policy implementation,insufficient implementation resources,and imperfect policies and regulations.On this basis,the causes are analyzed in depth in four dimensions: policy goals and standards,policy resources and system environment,organizational communication and implementation methods,implementation agency characteristics and implementer value orientation,and finally,around the goal of improving the quality and effectiveness of Pengzhou’s health insurance payment reform,we propose enhancing the incentive benefits of payment reform for medical institutions,optimizing the implementation environment of payment reform,improving the implementation of payment reform Finally,we propose feasible suggestions to enhance the incentive benefits of payment reform for medical institutions,optimize the implementation environment of payment reform,improve the implementation efficiency of payment reform,and improve the organizational structure of the medical system,so as to improve the quality of medical services and the satisfaction of the public,and to provide reference for the establishment of a useful and efficient medical insurance payment method.更多还原