【摘要】：研究目的本研究旨在了解京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時(shí)結(jié)報(bào)的基本情況,進(jìn)而分析即時(shí)結(jié)報(bào)過(guò)程中涉及的主要利益相關(guān)者,探究主要利益相關(guān)者與京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時(shí)結(jié)報(bào)之間的影響,從而為京津冀地區(qū)跨省就醫(yī)即時(shí)結(jié)報(bào)工作提供建議。研究?jī)?nèi)容1.梳理異地就醫(yī)即時(shí)結(jié)報(bào)、利益相關(guān)者的相關(guān)概念、內(nèi)涵、理論和國(guó)內(nèi)外研究現(xiàn)狀、實(shí)踐經(jīng)驗(yàn)。2.分析京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時(shí)結(jié)報(bào)的政策制度、信息技術(shù)、業(yè)務(wù)流程和結(jié)算方式,并歸納所面臨的主要問(wèn)題。3.利用利益相關(guān)者分析方法,分析京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時(shí)結(jié)報(bào)的主要利益相關(guān)者的關(guān)聯(lián)程度、執(zhí)行意愿和政策影響力。4.探討主要利益相關(guān)者與京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時(shí)結(jié)報(bào)之間的影響,結(jié)合即時(shí)結(jié)報(bào)存在問(wèn)題與利益相關(guān)者分析結(jié)果,提出相應(yīng)的建議。研究方法1.資料來(lái)源:(1)文獻(xiàn)研究:通過(guò)在中外文獻(xiàn)數(shù)據(jù)庫(kù)以及政府門(mén)戶(hù)網(wǎng)站檢索與研究主題相關(guān)的文獻(xiàn)資料,系統(tǒng)梳理相關(guān)理論和國(guó)內(nèi)外實(shí)踐;(2)現(xiàn)場(chǎng)調(diào)查:通過(guò)問(wèn)卷調(diào)查及半結(jié)構(gòu)式訪談,了解京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時(shí)結(jié)報(bào)的政策制定及實(shí)施狀況。2.研究方法:(1)利益相關(guān)者分析法:確定京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時(shí)結(jié)報(bào)工作中涉及的主要利益相關(guān)者,并利用分析指標(biāo),借助問(wèn)卷調(diào)查和深入訪談,了解各主要利益相關(guān)者的特征;(2)專(zhuān)家咨詢(xún)法:先后在設(shè)計(jì)調(diào)查問(wèn)卷、確定利益相關(guān)者、確定主要利益相關(guān)者及確定分析指標(biāo)階段咨詢(xún)專(zhuān)家學(xué)者;(3)描述性統(tǒng)計(jì)分析法:對(duì)問(wèn)卷調(diào)查、深入訪談和專(zhuān)家咨詢(xún)中收集的定性、定量資料運(yùn)用常用的統(tǒng)計(jì)學(xué)方法處理分析。結(jié)果1.京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時(shí)結(jié)報(bào)的基本情況政策制度方面,京津冀三地的統(tǒng)籌補(bǔ)償政策、報(bào)銷(xiāo)政策呈現(xiàn)差異化,均強(qiáng)調(diào)轉(zhuǎn)診制度。信息化建設(shè)方面,京津冀三地的管理信息系統(tǒng)建設(shè)、醫(yī)療機(jī)構(gòu)聯(lián)網(wǎng)結(jié)報(bào)、結(jié)算平臺(tái)建立以及配套信息系統(tǒng)建設(shè)存在差異。業(yè)務(wù)流程方面,京津冀地區(qū)按照就醫(yī)管理、登記備案、預(yù)付金管理、醫(yī)療費(fèi)用結(jié)算、醫(yī)療費(fèi)用清算的五個(gè)步驟進(jìn)行。試點(diǎn)應(yīng)用方面,京津冀地區(qū)目前尚未針對(duì)參保農(nóng)民的跨省就醫(yī)即時(shí)結(jié)報(bào)進(jìn)行即時(shí)結(jié)報(bào)試點(diǎn),但其他領(lǐng)域已設(shè)計(jì)出“面對(duì)面”結(jié)報(bào)模式。存在問(wèn)題方面,京津冀地區(qū)在開(kāi)展即時(shí)結(jié)報(bào)工作中面臨著城鄉(xiāng)居民醫(yī)保的統(tǒng)籌層次低且不一、即時(shí)結(jié)報(bào)的信息化建設(shè)參差不齊以及欠缺系統(tǒng)規(guī)劃等主要問(wèn)題。2.京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時(shí)結(jié)報(bào)的利益相關(guān)者分析京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時(shí)結(jié)報(bào)的主要利益相關(guān)者分別為人社部門(mén)、衛(wèi)生行政部門(mén)、醫(yī)保經(jīng)辦機(jī)構(gòu)、就醫(yī)地醫(yī)療機(jī)構(gòu)、參保地醫(yī)療機(jī)構(gòu)和參保農(nóng)民。主要利益相關(guān)者的角色定位、利益、立場(chǎng)、聯(lián)盟、資源、權(quán)力和領(lǐng)導(dǎo)能力的不同程度影響了相關(guān)者的關(guān)聯(lián)程度、執(zhí)行意愿和政策影響力。人社部門(mén)具有高關(guān)聯(lián)程度、高政策影響力,持支持態(tài)度;衛(wèi)生行政部門(mén)具有低關(guān)聯(lián)程度、中等政策影響力,持支持態(tài)度;醫(yī)保經(jīng)辦機(jī)構(gòu)具有高關(guān)聯(lián)程度、較高政策影響力,持較支持態(tài)度;就醫(yī)地醫(yī)療機(jī)構(gòu)具有高關(guān)聯(lián)程度、較高政策影響力,持中立態(tài)度;參保地醫(yī)療機(jī)構(gòu)具有低關(guān)聯(lián)程度、較低政策影響力,持中立態(tài)度;參保農(nóng)民具有高關(guān)聯(lián)程度、較低政策影響力,是最大利益受益者,持支持態(tài)度。結(jié)論1.人社部門(mén)、醫(yī)保經(jīng)辦機(jī)構(gòu)和就醫(yī)地醫(yī)療機(jī)構(gòu)與京津冀地區(qū)即時(shí)結(jié)報(bào)工作關(guān)聯(lián)程度高,具有較強(qiáng)的政策影響力,需加強(qiáng)三個(gè)部門(mén)(機(jī)構(gòu))在京津冀地區(qū)即時(shí)結(jié)報(bào)工作中的執(zhí)行意愿。對(duì)于人社部門(mén),需調(diào)動(dòng)人員的工作積極性以及加強(qiáng)統(tǒng)籌規(guī)劃與協(xié)調(diào)能力;對(duì)于醫(yī)保經(jīng)辦機(jī)構(gòu),需調(diào)動(dòng)人員的工作積極性以及規(guī)避醫(yī)保資金風(fēng)險(xiǎn)問(wèn)題;對(duì)于就醫(yī)地醫(yī)療機(jī)構(gòu),需確保醫(yī)保報(bào)銷(xiāo)費(fèi)用在規(guī)定時(shí)限內(nèi)回款。盡管參保農(nóng)民的政策影響力小,但是作為最大利益受益者,需考慮不同類(lèi)型參保農(nóng)民的跨省就醫(yī)需求,因人制宜。2.主要利益相關(guān)者對(duì)京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時(shí)結(jié)報(bào)的系統(tǒng)規(guī)劃、統(tǒng)籌層次和信息化建設(shè)產(chǎn)生影響,而京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時(shí)結(jié)報(bào)為主要利益相關(guān)者帶來(lái)了風(fēng)險(xiǎn)監(jiān)管和激勵(lì)約束的問(wèn)題。建議1.協(xié)調(diào)即時(shí)結(jié)報(bào)工作中主要利益相關(guān)者的利益關(guān)系;2.逐步提高京津冀地區(qū)基本醫(yī)保制度統(tǒng)籌層次;3.加快信息化建設(shè),為跨省就醫(yī)即時(shí)結(jié)報(bào)夯實(shí)基礎(chǔ);4.加強(qiáng)風(fēng)險(xiǎn)控制,實(shí)施有效監(jiān)管;5.建立考核機(jī)制和激勵(lì)約束機(jī)制;6.樹(shù)立整體觀,通過(guò)系統(tǒng)規(guī)劃形成制度合力。
[Abstract]:Objective The purpose of this study is to understand the basic situation of the instant report of the insured peasants'cross-provincial medical treatment in Beijing-Tianjin-Hebei region, and then analyze the main stakeholders involved in the process of the instant report, and explore the influence between the main stakeholders and the instant report of the insured peasants' cross-provincial medical treatment in Beijing-Tianjin-Hebei region, so as to make the cross-provincial medical treatment in Beijing-Tianjin- Research contents 1. Combine the related concepts, connotations, theories and research status at home and abroad, practical experience. 2. Analyze the policy system, information technology, business processes and settlement methods of the instant report of the insured peasants in Beijing-Tianjin-Hebei region, and summarize the main problems faced. Key issues. 3. Using stakeholder analysis method, this paper analyzes the correlation degree, willingness to implement and policy influence of the main stakeholders in the instant report of the insured peasants'cross-provincial medical treatment in Beijing-Tianjin-Hebei region. 4. Discusses the influence between the main stakeholders and the instant report of the insured peasants' cross-provincial medical treatment in Beijing-Tianjin-Hebei region. Data sources: (1) Literature research: Systematically combing the relevant theories and practices at home and abroad by searching and researching relevant literature materials in Chinese and foreign literature databases and government portals; (2) Field survey: through questionnaire survey and semi-structured interviews, Methods: (1) Stakeholder analysis: Determine the main stakeholders involved in the work of instant medical report of the insured peasants in Beijing-Tianjin-Hebei region, and use the analysis indicators, with the help of questionnaires and in-depth interviews, to understand the main stakeholders. Characteristics of stakeholders; (2) Expert consultation method: the design of questionnaires to identify stakeholders, identify major stakeholders and determine the stage of analysis indicators consultation experts and scholars; (3) Descriptive statistical analysis: questionnaire survey, in-depth interviews and expert consultation collected in qualitative, quantitative data using commonly used statistical methods Result 1. The basic situation and policy system of the instant medical report of the insured peasants in Beijing-Tianjin-Hebei region, the overall compensation policy and the reimbursement policy in Beijing-Tianjin-Hebei region are different, all of which emphasize the referral system. In the aspect of business process, Beijing-Tianjin-Hebei region has not carried out the real-time settlement test for the cross-provincial medical treatment report of the insured peasants. However, other areas have designed a "face-to-face" reporting model. The existing problems, Beijing-Tianjin-Hebei region in the implementation of immediate reporting work is faced with the low and different levels of urban and rural residents'medical insurance, the information construction of immediate reporting is uneven and the lack of systematic planning and other major issues. 2. Beijing-Tianjin-Hebei region insured farmers cross-province. Stakeholder analysis of medical immediate report in Beijing-Tianjin-Hebei region People's and social sectors have high degree of association, high policy influence and supportive attitude; health administrative departments have low degree of association, medium policy influence and supportive attitude; medical insurance agencies have high degree of association and higher political power. Policy influence and relatively supportive attitude; local medical institutions have high degree of association, higher policy influence and neutral attitude; medical institutions in the insured areas have low degree of association, lower policy influence and neutral attitude; farmers in the insured areas have high degree of association, lower policy influence, and are the biggest beneficiaries of support attitude. Conclusion 1. People's and social departments, medical insurance agencies and local medical institutions have a high degree of correlation with the work of immediate reporting in Beijing-Tianjin-Hebei region, and have a strong policy influence. It is necessary to strengthen the willingness of the three departments (institutions) to implement the work of immediate reporting in Beijing-Tianjin-Hebei region. For medical insurance agencies, it is necessary to mobilize the enthusiasm of staff and avoid the risk of medical insurance funds; for local medical institutions, it is necessary to ensure that the reimbursement fees of medical insurance are paid back within the prescribed time limit. The main stakeholders have an impact on the system planning, overall planning level and information construction of the cross-provincial medical report of the insured peasants in Beijing-Tianjin-Hebei region, while the cross-provincial medical report of the insured peasants in Beijing-Tianjin-Hebei region has brought about the problems of risk supervision and incentive and constraint for the main stakeholders. To coordinate the interests of the major stakeholders in the immediate report; 2. to gradually improve the overall level of the basic medical insurance system in Beijing-Tianjin-Hebei region; 3. to speed up the construction of information technology to lay a solid foundation for the immediate report of inter-provincial medical treatment; 4. to strengthen risk control and implement effective supervision; 5. to establish an assessment mechanism and incentive and restraint mechanism; 6. to establish a holistic view and pass System planning creates a system of synergy.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R197.1;F842.684;F323.89

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 盛芳;;請(qǐng)給參保農(nóng)民一張“明白紙”[J];科技致富向?qū)?2009年17期

2 李連忠;;四百多萬(wàn)參保農(nóng)民領(lǐng)養(yǎng)老金[J];勞動(dòng)保障世界;2008年05期

3 楊曉蓉;;新型農(nóng)村合作醫(yī)療制度存在的問(wèn)題及對(duì)策[J];山西財(cái)稅;2011年05期

4 ;民生看點(diǎn)[J];社會(huì)工作上半月(實(shí)務(wù));2008年05期

5 曲士彬;;對(duì)新型農(nóng)村合作醫(yī)療保障能力及改善的思考——以參保農(nóng)民的視角為探點(diǎn)[J];中國(guó)商界(下半月);2009年06期

6 劉智寶;劉紅玲;;建設(shè)誠(chéng)信體系 加快現(xiàn)行農(nóng)保制度改革[J];山東勞動(dòng)保障;2006年09期

7 ;卡到人 機(jī)到村 錢(qián)到賬——大悟農(nóng)行服務(wù)參保農(nóng)民廣受歡迎[J];湖北農(nóng)村金融研究;2012年05期

8 榮伏林;高志遠(yuǎn);;不要讓新時(shí)期農(nóng)村的“希望工程”打折扣[J];中國(guó)財(cái)政;2007年06期

9 黃偉;;參保農(nóng)民工持《就醫(yī)卡》便可看病報(bào)銷(xiāo)[J];家庭醫(yī)學(xué).新健康;2006年06期

10 趙琨;邴興濤;;山東萊西:逐步完善新型農(nóng)村合作醫(yī)療制度[J];中國(guó)財(cái)政;2006年05期

相關(guān)重要報(bào)紙文章 前10條

1 楊麗佳;江蘇參保農(nóng)戶(hù)比重大于參保農(nóng)民[N];健康報(bào);2007年

2 首席記者 王森;本市種植業(yè)參保農(nóng)民得實(shí)惠[N];盤(pán)錦日?qǐng)?bào);2009年

3 俞志新 李水根;參保農(nóng)民 也需維權(quán)[N];健康報(bào);2006年

4 徐惠芬;景寧：一條審計(jì)建議惠及全縣參保農(nóng)民[N];中國(guó)審計(jì)報(bào);2007年

5 通訊員 錢(qián)育斌 記者 楊新明;如東參保農(nóng)民有望增16萬(wàn)人[N];南通日?qǐng)?bào);2008年

6 錢(qián)建虎邋通訊員 張喜 劉新春;白米投入120萬(wàn)提高農(nóng)民醫(yī)保標(biāo)準(zhǔn)[N];泰州日?qǐng)?bào);2007年

7 本報(bào)記者 顏敏丹邋本報(bào)通訊員 章君芳;黃巖參保農(nóng)民可刷卡即時(shí)補(bǔ)償[N];臺(tái)州日?qǐng)?bào);2008年

8 羅月琴;福鼎參保農(nóng)民看病可報(bào)銷(xiāo)[N];閩東日?qǐng)?bào);2006年

9 記者 曹運(yùn)生;優(yōu)化保險(xiǎn)服務(wù) 給參保農(nóng)民實(shí)惠[N];運(yùn)城日?qǐng)?bào);2007年

10 馮玉燕;突泉縣為4.36萬(wàn)名參保農(nóng)民建立檔案[N];內(nèi)蒙古日?qǐng)?bào)(漢);2010年

相關(guān)碩士學(xué)位論文 前4條

1 劉伊凡;京津冀地區(qū)參保農(nóng)民跨省就醫(yī)即時(shí)結(jié)報(bào)的利益相關(guān)者分析[D];北京協(xié)和醫(yī)學(xué)院;2017年

2 徐波;江山市新型農(nóng)村合作醫(yī)療參保農(nóng)民住院費(fèi)用及補(bǔ)償研究[D];蘇州大學(xué);2010年

3 孫自學(xué);區(qū)域縱向醫(yī)療聯(lián)合體關(guān)鍵利益相關(guān)者分析及其系統(tǒng)模擬研究[D];第二軍醫(yī)大學(xué);2017年

4 胡坤;衛(wèi)生領(lǐng)域利益相關(guān)者分析：方法學(xué)和醫(yī)藥改革評(píng)價(jià)研究[D];山東大學(xué);2007年

，

本文編號(hào)：2231373