专科论文定稿.docVIP

摘要：本文概述了我国由公费和劳保医疗制度转变到社会保障体制的过程，分析了医保制度改革的必要性。其支付标准目前全部采用DRGs付费，又称按病种预付制，通过考虑病例特征，并根据病情严重程度和医疗服务强度对每个病种分别制定价格，保险基金会按DRGs的价格向医院一次性付费，建立了医院自我控制医药费用的机制，从而遏制了住院诊治费用的不合理上涨。本文列举了天津市医疗保险的发展和现行政策，以及目前医院医保管理所面临的问题，如医疗费用增长过快、下达指标不足等问题，并提出了解决方案。 关键词：医疗保险；医院管理；社会保障；药品管理 Tianjin medical insurance system reform in hospital medical insurance management research Liu Rui (College of Politics and Administration, Tianjin Normal University) Abstract: this article summarizes the transition from public expense and labor medicare system process to the social security system, analyzes the necessity of the reform of the medical insurance system. Its pay standards currently all adopt DRGs pay, also knowned as prepaid according to cases characteristics.According to the illness characteristics, severity and medical service intensity, formulate price respectively.The insurance fund pay to hospital one-time according to DRG’s price, which established the control mechanism of medical expenses by hospital itself, curbed the hospitalization treatment costs unreasonable rise. Through the introduction of foreign medical insurance system, it deepens that the reform of the medical insurance system in China is imperative. This article lists the development and current policy of tianjin medical insurance, and many problems faced by the current hospital medical insurance management, such as the overgrowth of medical expenses, the shortage of target, and so on, and put forward solutions. Keywords: medical insurance, the hospital management, social security; drug management 目录 一、天津市医疗保险的发展以及医院管理的现状 11 （一）天津市医疗保险的发展概况 11 （二）现行医疗保险制度下医院面临的问题 2 二、形成当前医疗保险现状的原因分析 43 （一）造成医疗费用持续增长的几点原因 3 （二）造成挂床住院的原因 3 三、加强医院医保管理的对策 44 （一）医院对外部的对策 44 （二）医院对医疗费不合理增长的控制 44 （三）对不规范医疗行为的管理 55 （四）积极处理好医、保、患三者的关系 66 参考文献 7 一、天津市医疗保险的发展以及医院管理的现状 （一）天津市医疗保险的发展概况 2001年11月始，天津市实施城镇职工基本医疗保险制度，几年来通过政策制度的调整完善，医疗保险覆盖范围不断扩大。塘沽区、开发区城镇职工医保与全市制度实现并轨，形成了医保制度的全市统筹；推动新农合与城镇居民医疗保险整合，实现城乡医保制度一体化，