本文關鍵詞： 醫(yī)保 單病種付費 滿意度 反饋　出處：《安徽醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：研究背景 廈門市基本醫(yī)療保險于2005年7月1日起正式實行部分疾病按單病種結算，至今已有九年時間，按病種付費病種由最初的8種增至現在的21種，單病種付費在實踐中不斷發(fā)展完善，但是關于患者對單病種付費以及醫(yī)保、醫(yī)療機構的運行及服務情況滿意與否，缺乏專業(yè)可靠的評價工具，患者方的評價與建議難以得到反饋。 國外單病種付費以及國內相關研究都在一定的程度上表明，單病種付費支付方式能夠控制醫(yī)療費用過快上漲、有效減少平均住院天數、使醫(yī)院改進費用及服務管理、促使醫(yī)院努力平衡醫(yī)保費用的使用，最終改善醫(yī)療服務質量。但是這些改良或結算是否獲得了患者的支持，在經濟效益得到有效提高和控制的同時是否獲得了預期的社會效益，仍缺乏相關研究與政策的支持。積極探索實行單病種付費的支付方式，進行醫(yī)保支付方式改革，最終目標還是服務患者和廣大人民群眾。 研究目的 本課題研究目的在于嘗試對廈門市三甲綜合醫(yī)院單病種付費實施的效果進行評價，試制評價工具，分析按病種付費在三甲綜合醫(yī)院實施中可推廣借鑒的優(yōu)勢及存在的問題，提出完善醫(yī)療保險按病種付費方式的方案。 研究內容 (1)編制單病種滿意度調查問卷，以問卷作為單病種滿意度研究體系的初級工具； (2)通過調查獲得廈門市單病種付費患者滿意度方面的數據，掌握影響滿意度的因素； (3)從獲得的數據入手，分析在制度制定與實施過程中存在的問題，歸納本研究中現存的不足。 研究方法 1、文獻檢索，資料查閱 查閱國內外單病種付費方式滿意度方面的文獻，搜集本市的相關文件政策資料，了解國家以及廈門本市基本醫(yī)療保險的文件、制度、政策及單病種付費的實施方案。 2、現場調查 （1）重要知情人訪談 采用重要知情人訪談的方法，了解按病種付費制訂的目標、項目的實施過程和成效，確認與滿意度影響有關的因素及維度。訪談對象包括市醫(yī)保中心工作人員、醫(yī)保中心結算辦工作人員、所調查醫(yī)院行政分管院長及醫(yī)保辦工作人員。 （2）滿意度問卷調查 通過文獻查閱及專家咨詢法，確定滿意度相關各指標及維度，根據美國顧客滿意度指數模型（ACSI）及中國醫(yī)院患者滿意度指數模型（CHPSI－05）的要素進行分析，編制針對單病種付費的滿意度調查問卷，分為自填問卷與電話隨訪問卷2類，對30～40名患者進行預調查，比較并檢驗問卷的信度及效度，通過重測信度等指標選擇合適的調查方式，，對所選問卷進行修改補充后，于所實習醫(yī)院對單病種付費住院患者進行抽樣調查，共300份，進行滿意度問卷調查，了解患者對當前單病種付費運行狀況的認知與滿意度情況。研究結果與主要發(fā)現 電話隨訪調查較適合對單病種付費病人的滿意度調查；患者的滿意度評價不一，但對醫(yī)技水平及責任感評價高，服務及時性及服務態(tài)度有待改善；患者及家屬對單病種付費的認知程度不足，相關知識較為缺乏；患者方對單病種運行的參與程度不足，缺少正式的滿意度反饋體系；提升醫(yī)療水平才是保證滿意度的重點。 政策建議 對于完善單病種滿意度研究的建議 1.進行聯(lián)合研究，分享研究資源 2.擴展研究時間，將病種間差異納入考量范圍 3.加大宣傳力度，妥善運用社會力量 對單病種付費制度本身的建議 1.建立專業(yè)的滿意度評價反饋體系 2.完善當前的費用核算機制 3.加強與患者的溝通解釋 4.避免院方的風險轉移 5.將臨床路徑與單病種付費有機結合 6.細化疾病診斷分組，適時向DRGs支付方式轉變
[Abstract]:Research background
The basic medical insurance in Xiamen City, the official implementation of part of the disease according to the single disease settlement in July 1, 2005, has been nine years, DRGs disease from 8 to 21 initially present, SingleDisease consummated continually, but on patients with single disease payment and medical insurance, medical service and operation the satisfaction, the lack of professional and reliable evaluation tool, evaluation and suggestion of the patient to get feedback.
Foreign SingleDisease and domestic relevant studies show that in a certain extent, single payment payment to the medical expense control is rising fast, effectively reduce the average hospitalization time, improve the cost and service management of the hospital, the hospital prompted the use of trying to balance the medical insurance cost, and ultimately improve the quality of medical service. But these improvements or whether the settlement get the patient support, effectively improve and control the economic benefits at the same time whether to obtain the desired social benefits, is still a lack of research and policy support. To actively explore the implementation of single disease payment, Medicare payment reform, the ultimate goal is to serve the patients and the broad masses of the people.
research objective
The purpose of this research is to try to tertiary comprehensive hospitals of Xiamen city SingleDisease implementation effect evaluation, trial evaluation tools, analysis the implementation of DRGs in three general hospitals can be used the advantages and existing problems, put forward to perfect the medical insurance according to the disease kinds of payment scheme.
research contents
(1) the questionnaire of single disease degree of satisfaction was compiled, and the questionnaire was used as the primary tool for the study system of the degree of satisfaction of single disease.
(2) through the survey to obtain the data of the degree of satisfaction of the single disease paid patients in Xiamen, and grasp the factors that affect the satisfaction.
(3) starting with the obtained data, the existing problems in the process of system formulation and implementation are analyzed, and the existing deficiencies in this study are summarized.
research method
1, literature retrieval, data access
Consult the literature about the satisfaction degree of the single disease payment method at home and abroad, collect relevant documents and policy information of the city, and understand the document, system, policy and implementation plan of the single disease payment of the state and the basic medical insurance in Xiamen.
2, field survey
(1) interviews with important lovers
By using the method of key informant interviews, to pay the goals set by disease, implementation process and results of the project, confirm the relevant factors and satisfaction and influence dimensions. The interviewees include city health center staff, medical insurance settlement center office staff survey, the hospital administrative Dean and medical insurance office staff.
(2) questionnaire survey of satisfaction
Through literature review and expert consultation method to determine the related indexes and satisfaction dimensions, according to the American customer satisfaction index (ACSI) and Chinese hospital patient satisfaction index model (CHPSI - 05) to analyze the factors for preparation of single transfer DRGs satisfaction questionnaire, divided into self-administered questionnaires and telephone follow-up questionnaire 2 categories. A pre survey was carried out in 30~40 patients, compare and test the reliability and validity of the scale, the test-retest reliability index were chosen to investigate the appropriate, revise the selected questionnaire after paying sampled hospitalized patients on single disease to hospitals, a total of 300, satisfaction questionnaire, cognition and satisfaction the current situation of SingleDisease operation condition of the patients understand the results and main findings.
鐢佃瘽闅忚璋冩煡杈冮

本文編號：1527608