朔州市城镇医保病人住院费用管理研究.pdf

山西财经大学
硕士学位论文
朔州市城镇医保病人住院费用管理研究
姓名:谭慧源
申请学位级别:硕士
专业:社会保障
指导教师:赵俊康
2010-03-30
摘要
医疗保障制度是社会保障制度的重要组成部分,它对国民健康以及经济和
社会发展有着重要作用,是国家的基本经济社会制度之一。它不仅仅与每个人
的生老病死密切相关,而且与整个社会的安全稳定密切相关。
现阶段我国的医疗保障问题倍受关注,这其中,医疗费用控制问题又是重
中之重,难中之难。自上世纪年代以来,各国面对快速上涨的医疗费用,
对医疗费用控制方式进行了深入探讨,并总结出有益的经验和进行了卓有效果
的实践。我国自年启动职工医疗保险改革以来,医疗保险制度已经深入
到城镇千家万户,在解决群众“看病难,看病贵”的问题上取得了极大的效果。
在实施的初期阶段,既保障参保职工的基本医疗需求,又有较好的费用控制效
果这个理想基本得到实现。但由于我国医疗保险制度建立晚,体系仍不完善,
面对不断高涨的医疗费用缺乏实际有效的控制手段,政策效应随时间递减。
为了更好的保障这项制度顺利执行下去,进行本研究。本文运用统计学理
论,以朔州市某医保定点医院城镇参保职工的住院费用为例,对朔州市城镇职
工医保过程及基本现状进行了分析,找出由统筹基金支付的医保病人住院费用
的影响因素、住院费用变化规律,总结了现行城镇职工医疗保险制度存在的几
个问题,并提出相应的管理建议和对策,以期为及时调整基本医疗保险政策,
对医保制度的进一步改革和完善提供参考依据。

【关键词】医保病人住院费用费用控制影响因素

3
Abstract

Medical security system is an ponent of social security system, and it plays an
influential role in the national health as well as economic and social development state. At the same
time it is one of the basic social and economic system. It’s not just closely related to each person's
childbirth, old age, sickness and funerals, but also linked with the security and stability of the whole
society.
At this stage ,the existing problems of China's medical insurance system attracting much
attention, of which, health care cost-control issues is the most important and the first work. Since
the 1970s, various countries facing with rapidly rising medical costs, has conducted in-depth study
on cost control approach and summed up the experience and carried out useful effective practice.
Our country has started the system of medical insurance for urban workers reform since 1998, the
system of medical care insurance have been already deep into the cities and towns millions of
households, in the resolution of the masses increasing contradictions of the difficult and expensive
medical treatment, made the issue a great effect. In the early stages of implementation, while
ensuring the basic medical needs of insured workers, have