“先看病后付费”制度改革的效果分析研究
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摘要
研究背景
“看病难、看病贵”和医患关系不协调是近年来医药卫生服务中存在的主要问题和社会矛盾,也是党和政府高度关注并积极解决的民生问题。从世界各国医疗费用交纳的情况来看,医疗保障制度建设和住院押金是否交纳密切相关。从现行国内医院服务收费方式来看,住院押金隐含潜在问题,影响医疗服务可及性,不利于医疗费用的控制,在增加医疗程序和医院工作量的同时,也增加了医院成本,并且存在医患诚信隐患,现行收费方式导致低收入阶层患者筹集住院押金压力大。新医改的核心就是突出卫生服务的公益性,而卫生服务的可及性和公平性是公益性的重要体现。“先看病后付费”服务模式能否提高卫生服务的可及性和公平性,进而表现卫生服务的公益性?这值得学术界进一步深入研究。“先看病后付费”诊疗服务模式是关注关心民生的探索创新,将进一步增进医患之间的信任关系,促进社会诚信建设,为社会和谐提供重大支持。
研究目的
在新医改的背景下,研究兖州市取消住院押金“先看病后付费”服务模式,探讨该模式的理论基础,分析该模式的应用条件、特点和风险,并且探索该模式在全国各地推广的可行性和操作性,以重构医患诚信,促进社会和谐,并为公立医院改革、促进社会主义核心价值观的诚信文化建设提供理论支持和可推广的应用模式。
研究方法
本研究采用随机分层抽样,选择兖州市中医院、兖州市乙医院、兖州市丙医院200名住院病人、200名门诊病人进行现场调查。在文献综述基础上,采用理论研究、卡方检验和方差分析、个人深入访谈和关键人物访谈、博弈和动力阻力分析等统计学定性定量研究方法对模式及推广的可行性进行评价。
主要研究结果
1.模式实施初期能够有效吸引病人,87.75%被调查者了解该模式,67%的患者是因为该模式前来就诊的。
2.研究结果显示,该模式能够简化入院服务流程,缓解“看病贵”情况,切实改善医患关系.
3.研究结果显示,绝大部分患者对该模式是欢迎和支持的,在医保资金提前垫付和及时支付的情况下,医院运行该模式具有可行性。
对策与建议
1.由政府制定相关政策推行该模式,明确相关条件、完善配套措施；
2.强化政府责任,为模式推广提供财政保障；
3.充分把握模式实施原则,在推广过程中采取分步实施步骤；
4.加强医院内部运行机制的改革,保证模式的作用与效果；
5.提供法律支持,保障“先看病后付费”住院医疗付费新模式有效实施。
Background
High expense in medical treatment and difficulty in going to see a doctor and unharmonious relationship between physicians and patients are the main problems and social contradictions in medical and health services in recent years, which are also the livelihood issues that the government is concerned about. At the point of view of medical expense paid all over the world, medical security system is closely related to whether deposit hospital is paid or not. From the current charge on medical service in domestic hospitals, there are some potential problems in deposit for inpatients. They could affect the accessibility of medical service, which may be not good to control medical costs. Deposit should raise the medical service expense and there is a concern about the physician and patient relationship while the procedure of receiving medical treatment and workload for medical staff will go up. The current charge pattern in hospitals tends to result in high pressure for low-income groups to pay the deposit. The heart of the new reform is to highlight the medical public welfare through accessibility and fairness to manifest. Whether the pattern of First-treat Post-paid in medical service improves the accessibility, fairness and even public welfare of medical service or not is worth to be further researched. First-treat Post-paid is an important innovation for public welfare, which will further enhance the trust between physicians and patients, promote the creation of social honesty, and provide significant support for social harmony.
Objectives
In the new medical reform background, we studied the First-treat Post-paid pattern in Yanzhou hospital. In the study, theory of the model was explored and the application conditions, characteristics and risk were analyzed, but also the feasibility and operability were investigated all over the country. This paper provided theoretical support and application patterns which can spread for public hospital reform and construction of integrity culture on the basis to reconstruct the physician-patient integrity and promote social harmony.
Date and Methods
The study used stratified random sampling. There were200inpatients,200outpatients of three hospitals in Yanzhou selected in the study. On the basis of literature review, qualitative and quantitative research methods were used, such as theoretical research, feasibility analysis, chi-square test, in-depth interview, game theory and dynamicdrag, to evaluate the model and the feasibility.
Main Results
Ⅰ. In the initial, the mode can effectively attract patients.87.75%of respondents understand the mode,67%of whom come to the hospital.
Ⅱ. The results show that the mode can simplify the process of service delivery, reduce the medical expense and effectively improve the physician-patient relationship.
Ⅲ. The results show that most patients support the mode. Running the mode in the hospital is feasible in the case of insurance funds paid advanced and timely.
Countermeasures and Suggestions
Ⅰ. The government makes a plan to implement the mode by developing policy, and providing related conditions and support measures;
Ⅱ. To strengthen the responsibility of government is to provide financial for mode implementation;
Ⅲ. Fully grasp the principles of the mode implementation and use the step-by-step method in the process;
Ⅳ. Strengthen the reform of the hospital internal operation to ensure the effect of mode;
Ⅴ. Provide legal support to protect the effective implementation of the new mode
“看病难、看病贵”和医患关系不协调是近年来医药卫生服务中存在的主要问题和社会矛盾,也是党和政府高度关注并积极解决的民生问题。从世界各国医疗费用交纳的情况来看,医疗保障制度建设和住院押金是否交纳密切相关。从现行国内医院服务收费方式来看,住院押金隐含潜在问题,影响医疗服务可及性,不利于医疗费用的控制,在增加医疗程序和医院工作量的同时,也增加了医院成本,并且存在医患诚信隐患,现行收费方式导致低收入阶层患者筹集住院押金压力大。新医改的核心就是突出卫生服务的公益性,而卫生服务的可及性和公平性是公益性的重要体现。“先看病后付费”服务模式能否提高卫生服务的可及性和公平性,进而表现卫生服务的公益性?这值得学术界进一步深入研究。“先看病后付费”诊疗服务模式是关注关心民生的探索创新,将进一步增进医患之间的信任关系,促进社会诚信建设,为社会和谐提供重大支持。
研究目的
在新医改的背景下,研究兖州市取消住院押金“先看病后付费”服务模式,探讨该模式的理论基础,分析该模式的应用条件、特点和风险,并且探索该模式在全国各地推广的可行性和操作性,以重构医患诚信,促进社会和谐,并为公立医院改革、促进社会主义核心价值观的诚信文化建设提供理论支持和可推广的应用模式。
研究方法
本研究采用随机分层抽样,选择兖州市中医院、兖州市乙医院、兖州市丙医院200名住院病人、200名门诊病人进行现场调查。在文献综述基础上,采用理论研究、卡方检验和方差分析、个人深入访谈和关键人物访谈、博弈和动力阻力分析等统计学定性定量研究方法对模式及推广的可行性进行评价。
主要研究结果
1.模式实施初期能够有效吸引病人,87.75%被调查者了解该模式,67%的患者是因为该模式前来就诊的。
2.研究结果显示,该模式能够简化入院服务流程,缓解“看病贵”情况,切实改善医患关系.
3.研究结果显示,绝大部分患者对该模式是欢迎和支持的,在医保资金提前垫付和及时支付的情况下,医院运行该模式具有可行性。
对策与建议
1.由政府制定相关政策推行该模式,明确相关条件、完善配套措施；
2.强化政府责任,为模式推广提供财政保障；
3.充分把握模式实施原则,在推广过程中采取分步实施步骤；
4.加强医院内部运行机制的改革,保证模式的作用与效果；
5.提供法律支持,保障“先看病后付费”住院医疗付费新模式有效实施。
Background
High expense in medical treatment and difficulty in going to see a doctor and unharmonious relationship between physicians and patients are the main problems and social contradictions in medical and health services in recent years, which are also the livelihood issues that the government is concerned about. At the point of view of medical expense paid all over the world, medical security system is closely related to whether deposit hospital is paid or not. From the current charge on medical service in domestic hospitals, there are some potential problems in deposit for inpatients. They could affect the accessibility of medical service, which may be not good to control medical costs. Deposit should raise the medical service expense and there is a concern about the physician and patient relationship while the procedure of receiving medical treatment and workload for medical staff will go up. The current charge pattern in hospitals tends to result in high pressure for low-income groups to pay the deposit. The heart of the new reform is to highlight the medical public welfare through accessibility and fairness to manifest. Whether the pattern of First-treat Post-paid in medical service improves the accessibility, fairness and even public welfare of medical service or not is worth to be further researched. First-treat Post-paid is an important innovation for public welfare, which will further enhance the trust between physicians and patients, promote the creation of social honesty, and provide significant support for social harmony.
Objectives
In the new medical reform background, we studied the First-treat Post-paid pattern in Yanzhou hospital. In the study, theory of the model was explored and the application conditions, characteristics and risk were analyzed, but also the feasibility and operability were investigated all over the country. This paper provided theoretical support and application patterns which can spread for public hospital reform and construction of integrity culture on the basis to reconstruct the physician-patient integrity and promote social harmony.
Date and Methods
The study used stratified random sampling. There were200inpatients,200outpatients of three hospitals in Yanzhou selected in the study. On the basis of literature review, qualitative and quantitative research methods were used, such as theoretical research, feasibility analysis, chi-square test, in-depth interview, game theory and dynamicdrag, to evaluate the model and the feasibility.
Main Results
Ⅰ. In the initial, the mode can effectively attract patients.87.75%of respondents understand the mode,67%of whom come to the hospital.
Ⅱ. The results show that the mode can simplify the process of service delivery, reduce the medical expense and effectively improve the physician-patient relationship.
Ⅲ. The results show that most patients support the mode. Running the mode in the hospital is feasible in the case of insurance funds paid advanced and timely.
Countermeasures and Suggestions
Ⅰ. The government makes a plan to implement the mode by developing policy, and providing related conditions and support measures;
Ⅱ. To strengthen the responsibility of government is to provide financial for mode implementation;
Ⅲ. Fully grasp the principles of the mode implementation and use the step-by-step method in the process;
Ⅳ. Strengthen the reform of the hospital internal operation to ensure the effect of mode;
Ⅴ. Provide legal support to protect the effective implementation of the new mode
引文
[1]http://www.hcaconnect.co.uk/payment.asp
[2]http://www.royalfree.nhs.uk/default.aspx?top_nav_id=1&tab_id=119
[3]http://tmc.gov.in/patientinfo/ipp.htm
[4]http://www.uamshealth.com/?id=23&sid=1
[5]http://www.kgu.de/en/patients/costs.html
[6]http://www.Medizin.uni-tuebingen.de/en/Patients/Arrival+to+discharge.html
[7]北海市人民医院党支部.艰苦创业勤俭办院[J].广西卫生,1973,(5)：21-24.
[8]邹长会.床头收费利弊谈[J].中国卫生经济,1987,(12)：38-39.
[9]吕臣,孟华,刘肖梅.对利益相关者理论的再认识[J].新会计,2009,(1).
[10]斯蒂芬·P·罗宾斯,戴维·A·德森佐,亨利·穆恩：《管理学原理》,北京：中国人民大学出版社,2008年,第297页.
[11]陈松林.信任源理论在医患关系管理中的运用[J].中华医院管理杂志,2006,22(12)：826-828.
[12]张桂芝,董兆举.构建和谐医患关系,实现医患“双赢”[J].中国医学伦理学,2007,20(6)：34-36.
[13]朱凤霞.诚信与医院形象的重塑[J].中国医学伦理学,2006,19(5)：34-35.
[14]王玲.对塑造医院品牌的若干认识[J].南京医科大学学报,2003,(10)：48-50.
[15]康益龙,王杉.医患关系的博弈分析[J].医学与哲学(人文社会医学版),2006,27(9)：14-16.
[16]范晓屏,吴中伦.诚信、信任、信用的概念及关系辨析[J].技术经济与管理研究,2005,(1)：98-99
[17]翟学伟.诚信、信任与信用：概念的澄清与历史的演进[J].江海学刊,2011,(5)：107-114.
[18]杨建华.论社会信任的重构2011年12月06日10：25来源：《光明日报》
[19]张萍.以病人为中心构建和谐医患关系[J].中国医院管理,2007,27(4)：62-63.
[20]刘激扬,田勇泉.医患关系问题与诚信的缺失[J].求索,007,(6)：69-71.
[21]刘威,鲍勇.患者信任对医疗服务质量的影响[J].中华医院管理杂志,2010,26(6)：42-426.
[22]Baier A. Trustandantitrust [J]. Ethics,1986,96:231-260.
[23]Safran D,Taira D,Rogers W,eta L Linking primary care performance to outcomes of care[J].Fam Pract,1998,47 (3):213-220.
[24]Thom D.Patient trust in the physician:relation to patient requests and requestful filment [J].Family Practice,2002,19 (5):476-483.
[25]Creed W, Miles Trust in organizations; a conceptual frame work linking organizational forms,managerial philosophies,and the opportunity costs of controls [M].In:Trust in organizations:frontiers of theory and research. Tyler T, KramerItM,Pals.ThousandOaks,CA, Sage Publications,1996:16-38.
[26]张建华,滕文杰,汤敏等.患方视角下医患关系的影响因素分析及政策探讨[J].中国医学伦理学,2011,24(2)：199-200.
[27]吕兆丰,王晓燕,张建,等.影响医患关系和谐的诸因素研究—全国十城市典型调查日[J],中国医院,2008,12(12)：32-40.
[28]王前强.激励相容与中国医改[J].中国医院管理,2009,(3).
[29]姚国庆：《博弈论》,天津：南开大学出版社,2003年,第5-6页.
[2]http://www.royalfree.nhs.uk/default.aspx?top_nav_id=1&tab_id=119
[3]http://tmc.gov.in/patientinfo/ipp.htm
[4]http://www.uamshealth.com/?id=23&sid=1
[5]http://www.kgu.de/en/patients/costs.html
[6]http://www.Medizin.uni-tuebingen.de/en/Patients/Arrival+to+discharge.html
[7]北海市人民医院党支部.艰苦创业勤俭办院[J].广西卫生,1973,(5)：21-24.
[8]邹长会.床头收费利弊谈[J].中国卫生经济,1987,(12)：38-39.
[9]吕臣,孟华,刘肖梅.对利益相关者理论的再认识[J].新会计,2009,(1).
[10]斯蒂芬·P·罗宾斯,戴维·A·德森佐,亨利·穆恩：《管理学原理》,北京：中国人民大学出版社,2008年,第297页.
[11]陈松林.信任源理论在医患关系管理中的运用[J].中华医院管理杂志,2006,22(12)：826-828.
[12]张桂芝,董兆举.构建和谐医患关系,实现医患“双赢”[J].中国医学伦理学,2007,20(6)：34-36.
[13]朱凤霞.诚信与医院形象的重塑[J].中国医学伦理学,2006,19(5)：34-35.
[14]王玲.对塑造医院品牌的若干认识[J].南京医科大学学报,2003,(10)：48-50.
[15]康益龙,王杉.医患关系的博弈分析[J].医学与哲学(人文社会医学版),2006,27(9)：14-16.
[16]范晓屏,吴中伦.诚信、信任、信用的概念及关系辨析[J].技术经济与管理研究,2005,(1)：98-99
[17]翟学伟.诚信、信任与信用：概念的澄清与历史的演进[J].江海学刊,2011,(5)：107-114.
[18]杨建华.论社会信任的重构2011年12月06日10：25来源：《光明日报》
[19]张萍.以病人为中心构建和谐医患关系[J].中国医院管理,2007,27(4)：62-63.
[20]刘激扬,田勇泉.医患关系问题与诚信的缺失[J].求索,007,(6)：69-71.
[21]刘威,鲍勇.患者信任对医疗服务质量的影响[J].中华医院管理杂志,2010,26(6)：42-426.
[22]Baier A. Trustandantitrust [J]. Ethics,1986,96:231-260.
[23]Safran D,Taira D,Rogers W,eta L Linking primary care performance to outcomes of care[J].Fam Pract,1998,47 (3):213-220.
[24]Thom D.Patient trust in the physician:relation to patient requests and requestful filment [J].Family Practice,2002,19 (5):476-483.
[25]Creed W, Miles Trust in organizations; a conceptual frame work linking organizational forms,managerial philosophies,and the opportunity costs of controls [M].In:Trust in organizations:frontiers of theory and research. Tyler T, KramerItM,Pals.ThousandOaks,CA, Sage Publications,1996:16-38.
[26]张建华,滕文杰,汤敏等.患方视角下医患关系的影响因素分析及政策探讨[J].中国医学伦理学,2011,24(2)：199-200.
[27]吕兆丰,王晓燕,张建,等.影响医患关系和谐的诸因素研究—全国十城市典型调查日[J],中国医院,2008,12(12)：32-40.
[28]王前强.激励相容与中国医改[J].中国医院管理,2009,(3).
[29]姚国庆：《博弈论》,天津：南开大学出版社,2003年,第5-6页.