基層醫(yī)療機(jī)構(gòu)實(shí)施國(guó)家基本藥物制度后的補(bǔ)償機(jī)制研究

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目 錄
第1章 緒論 5
1.1研究背景 5
1.2研究目的和意義 6
1.2.1研究目的 6
1.2.2研究意義 6
1.2.3創(chuàng)新點(diǎn)和不足 6
1.3國(guó)內(nèi)外研究綜述 7
1.3.1國(guó)外研究綜述 7
1.3.2國(guó)內(nèi)研究綜述 7
1.4確定基層醫(yī)療機(jī)構(gòu)補(bǔ)償機(jī)制的方法與模型 11
1.4.1按就診人頭補(bǔ)償藥品差價(jià) 11
1.4.2時(shí)間序列模型 11
第2章 基本概念及相關(guān)理論 13
2.1相關(guān)基本概念 13
2.1.1基本藥物制度的概念 13
2.1.2基層醫(yī)療機(jī)構(gòu)的概念 13
2.1.3醫(yī)療機(jī)構(gòu)補(bǔ)償機(jī)制的概念 14
2.2基層醫(yī)療機(jī)構(gòu)補(bǔ)償機(jī)制的相關(guān)理論 15
2.2.1補(bǔ)償績(jī)效理論 15
2.2.2時(shí)間序列分析與時(shí)間序列預(yù)測(cè)法 16
第3章 江蘇省基層醫(yī)療機(jī)構(gòu)補(bǔ)償機(jī)制現(xiàn)狀分析 17
3.1抽樣地區(qū)基層醫(yī)療機(jī)構(gòu)補(bǔ)償主體的基本情況分析 17
3.1.1連云港贛榆縣基層醫(yī)療機(jī)構(gòu)補(bǔ)償主體概況 17
3.1.2鎮(zhèn)江市丹徒區(qū)基層醫(yī)療機(jī)構(gòu)補(bǔ)償主體概況 17
3.1.3常州溧陽(yáng)市基層醫(yī)療機(jī)構(gòu)補(bǔ)償主體概況 17
3.2抽樣地區(qū)基層醫(yī)療機(jī)構(gòu)補(bǔ)償方式的基本情況分析 18
3.2.1連云港贛榆縣基層醫(yī)療機(jī)構(gòu)補(bǔ)償方式概況 18
3.2.2鎮(zhèn)江市丹徒區(qū)基層醫(yī)療機(jī)構(gòu)補(bǔ)償方式概況 18
3.2.3常州市溧陽(yáng)市基層醫(yī)療機(jī)構(gòu)補(bǔ)償方式概況 18
3.3 江蘇省抽樣地區(qū)基層醫(yī)療機(jī)構(gòu)補(bǔ)償標(biāo)準(zhǔn)的基本情況分析 19
3.3.1抽樣地區(qū)基層醫(yī)療機(jī)構(gòu)的補(bǔ)償標(biāo)準(zhǔn)現(xiàn)狀 19
3.3.2抽樣地區(qū)基層醫(yī)療機(jī)構(gòu)補(bǔ)償標(biāo)準(zhǔn)的預(yù)測(cè)分析 21
第4章 完善我國(guó)基層醫(yī)療機(jī)構(gòu)補(bǔ)償機(jī)制的對(duì)策建議 26
4.1 補(bǔ)償主體多元化 26
4.2 補(bǔ)償方式合理化 26
4.3 補(bǔ)償標(biāo)準(zhǔn)科學(xué)化 27
4.4 適當(dāng)調(diào)整醫(yī)療服務(wù)價(jià)格 27
結(jié) 論 29
致 謝 31
參考文獻(xiàn) 32

摘要
目的:本文通過對(duì)建立合理的基層醫(yī)療機(jī)構(gòu)補(bǔ)償機(jī)制這一命題的探索研究,以期明確基層醫(yī)療機(jī)構(gòu)實(shí)施國(guó)家基本藥物制度后的補(bǔ)償主體及各自承擔(dān)的責(zé)任、確定基層醫(yī)療機(jī)構(gòu)實(shí)施國(guó)家基本藥物制度后的合理補(bǔ)償方式、確定基層醫(yī)療機(jī)構(gòu)實(shí)施國(guó)家基本藥物制度后的補(bǔ)償標(biāo)準(zhǔn)，為今后基層醫(yī)療機(jī)構(gòu)補(bǔ)償機(jī)制的完善提供理論指導(dǎo)和科學(xué)依據(jù)，促進(jìn)基層醫(yī)療機(jī)構(gòu)平穩(wěn)運(yùn)行、健康發(fā)展。
方法:（1）通過現(xiàn)場(chǎng)調(diào)查及現(xiàn)場(chǎng)訪談方法收集江蘇省3個(gè)地區(qū)所有基層醫(yī)療機(jī)構(gòu)的財(cái)務(wù)收支等資料，并了解和比較醫(yī)改部門相關(guān)的政策措施及意見；（2）通過 Excel 對(duì)樣本地區(qū)調(diào)查數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析，比較零差率銷售前后基層醫(yī)療機(jī)構(gòu)收支構(gòu)成及醫(yī)療服務(wù)開展的變化情況；（3）利用樣本地區(qū)基層醫(yī)療機(jī)構(gòu)以往的業(yè)務(wù)收入數(shù)據(jù)，構(gòu)建基層醫(yī)療機(jī)構(gòu)業(yè)務(wù)收入的時(shí)間序列模型，對(duì)基層醫(yī)療機(jī)構(gòu)財(cái)務(wù)補(bǔ)償標(biāo)準(zhǔn)進(jìn)行科學(xué)測(cè)算。
結(jié)論:現(xiàn)行的補(bǔ)償機(jī)制在補(bǔ)償主體、補(bǔ)償方式、補(bǔ)償標(biāo)準(zhǔn)等方面仍然存在不明確之處，建議通過以下幾方面完善：(1)補(bǔ)償主體多元化，堅(jiān)持以政府為主導(dǎo)的對(duì)基層醫(yī)療機(jī)構(gòu)進(jìn)行補(bǔ)償，合理劃分各級(jí)政府的投入責(zé)任；(2)補(bǔ)償方式合理化，按就診人頭補(bǔ)償藥品差價(jià)；(3)補(bǔ)償標(biāo)準(zhǔn)科學(xué)化，建立一套考核指標(biāo)體系；(4)適當(dāng)調(diào)整醫(yī)療服務(wù)價(jià)格，降低財(cái)政資金壓力等途徑保證基層醫(yī)療機(jī)構(gòu)的財(cái)政投入，完善補(bǔ)償機(jī)制，促進(jìn)國(guó)家基本藥物制度的可持續(xù)實(shí)施。
關(guān)鍵詞：補(bǔ)償機(jī)制 基層醫(yī)療機(jī)構(gòu) 基本藥物制度

Abstract
Objective: This article through exploring and researching on the topic of establishing reasonable compensation mechanism in primary health care institutions,hoping to determine the main part of compensation mechanismcompensation including their respective responsibilities of the primary health care institutions after implementing the essential drugs system,and determine a reasonable way to compensate after the implementation of the national essential drug system of primary health care institutions, and determine the compensation standard of primary health care institutions after the implementation of the national essential drug system,so can provide theoretical guidance and scientific basis for the improvement of compensation mechanism in the primary health care institutions,and promote the smooth operation and healthy development of primary health care institutions.
Methodology:(1)Collecting financial incomes and expenses and other informations of all the primary health care insititutions in three regions of Jiangsu Province by the means of site surveys and on-site interviews,and understanding and comparing the policies and views of government departments.(2) Statistical analysis of the data sample area through EXCEL,comparing the changes between before the drug's zero profit sales and after the drug's zero profit sales on the constitute of revenue and expenditurein,also medical services's conduct in primary health care institutions. (3)Taking use of the past business income data of sample areas's primary health care institutions,building time series model of business revenue,and doing the scientific calculations of compensation standards.
Results:Now the compensation mechanism remains unclear somewhere,such as the main part of compensation, the way of compensation,the standard of compensation and other aspects,we suggested that it improved by the following aspects:(1) Diversification of the main part of compensation,persisting the dominance of government,legitimately dividing the responsibility of all levels of government;(2) Rationalization of the compensation,compensating drug's price scissors by the number of patients;(3) Making the compensation standard scientificly,and establishing a set of eva luation system which regards the quantity and quality of service as the c..