导　　师： 黎东生

学科专业： 120402

授予学位： 硕士

作　　者： ;

机构地区： 广州中医药大学

摘　　要： 我国自上世纪八十年代以来,不断深化医疗体制改革,经过十多年的探索,初步建立了符合市场经济体制的,以覆盖城乡居民的基本医疗保险制度为主体,包括城镇职工基本医疗保险制度、城镇居民基本医疗保险制度、新型农村合作医疗制度、公费医疗四种基本医疗保障制度和商业医疗保险制度的多层次医疗保障体系,完成了理论上的医保全民覆盖,医疗卫生事业取得了很大的成绩。但是,近几年来,“看病难、看病贵”的问题逐渐突出,医疗费用上涨过快成为老百姓最关心、最希望得到解决的问题。 本文主要采用文献分析法、案例研究法和比较分析法等方法进行综合研究。研究的目的是针对目前政府在新医改方案中提出的“要探索建立医疗保险经办机构与医疗机构的谈判机制和付费方式改革,发挥医疗保障对医疗费用的制约作用”,探讨建立符合我国国情的医疗保险价格谈判机制。研究的结果表明,医疗保险谈判机制对于医疗费用的增长有明显的制约作用。 本研究的主要内容包括社会医疗保险价格谈判机制的内涵、产生原因,国外控制医疗保险费用的措施,以及如何构建我国社会医疗保险价格谈判机制等内容。医疗卫生体制的改革是关系到政府、老百姓、医疗服务机构、医疗保险机构、药品生产企业和药品供应商等几大群体的利益,只有建立一种平衡、协调各方利益的机制,才能够解决当前我国医疗服务市场的困局,彻底解决老百姓的“看病难、看病贵”问题。 医疗卫生体制的改革是不能一蹴而就,建立医疗保险谈判机制只是改革的开始。医疗卫生体制改革的成功还需要政府在财政投入、公立医院回归“公益性”、建立单病种付费制度或DRGs预付制度等方面有所突破。本研究还有很多的局限性,需要在其它方面展开更深入的调查研究,才能对我国的医疗卫生体制改革有所贡献。 Since 1980s, Our country deepening the reform of medical system. After more than ten years of exploration, Our country initially established a basic medical insurance system that cover urban and rural residents. This basic medical insurance system including basic medical insurance system for urban employees, urban resident basic medical insurance system, the new rural cooperative medical system, free medical care and the commercial medical insurance system. The multi-level medical service system have get great achievements. But in recent years, the problem of "Difficult Medical Services and Expensive Medical Cost" are gradually outstanding. The problem of medical expenses grow up too quickly. And become the most important problem that people are most concerned about and most wants to be resolved. This paper mainly adopts synthesis methods such as literature analytic method, case research and comparison analytic method etc. The purpose of the research is aimed at the current government in new medical scheme proposed "explore to establish the medical insurance price negotiation mechanism between medical insurance company and medical institutions and reform the payment system, control the growth of medical expenses". The results of the study show that the medical insurance negotiation mechanism have obvious effect to restrict the growth of medical expenses. The study concluded that medical health system reformation is related to several parties'interests such as the government, civilians, medical service agencies, medical insurance institutions, pharmaceutical production enterprise and pharmaceutical suppliers and so on. If we want to completely solve the problem of "Difficult Medical Services and Expensive Medical Cost", we need to estabish a system to coordinating the interests of all parties. Medical health system reformation is not overnight, establish the medical insurance negotiation mechanism is the beginning of the reformation. The success of Medical health system reform also depend on the financial investment of government, public hospital regression "pro bono", established DRGs advanced payment system and so on. There are a lot of limitations of this study, and many problems are needed to be investigated.

关 键 词： 社会医疗保险 谈判机制 价格

分 类 号： [F842.6]

领　　域： [经济管理]