摘要
目的运用鱼骨图模型分析社区卫生服务中心医疗费用不合理增长的原因,并提出对策与建议。方法运用鱼骨图理论模型,从文化背景、外部环境、制度体系、管理能力以及服务的提供方和需要方6个方面分析医疗费用不合理增长的原因。结果医疗保险费用的不合理增长不是一个单因素问题,文化背景方面主要是行政管理者都认为医疗费用是医院的收入,长期形成的收入越多越好的文化理念;外部环境主要是医患关系紧张,为避免因误诊带来的纠纷,从而发生了过度诊疗行为;制度体系方面主要是医疗保险费用核定采取"历史模型"的方式,各级医疗机构每年希望超一部分,为明年预算做铺垫;服务提供者问题主要是处方权医生的个人趋利行为;服务对象主要是由于医保对服务对象没有限制性。结论医疗保险费用的不合理增长是一个多因素的问题,控制医疗费用的不合理增长需要完善顶层设计,解决制度体系问题;提高医生待遇,杜绝医生的趋利行为;改变患者的就医行为,建立良好有效的医疗秩序;同时借鉴和落实国外家庭医生管理医疗保险费用的模式,将签约权和基金使用权有机结合,通过强制社区首诊、全科与专科的双向转诊等举措,由家庭医生管理疾病和控制费用。
OBJECTIVE To analyze the reasons of unreasonable increase of medical expenses in community health service center by using fishbone diagram model,and put forward countermeasures and suggestions.METHODS Using the fishbone diagram theory model,it analyzes the reasons for the unreasonable growth of medical expenses from 6 aspects:cultural background,external environment,institutional system,management ability and service providers and needs.RESULTS The unreasonable increase of medical insurance cost is not a single factor problem.In terms of cultural background,it is mainly the cultural idea that the administrators believe that the medical cost is the income of the hospital,the more the income formed in a long time,the better;the external environment is mainly the tense relationship between doctors and patients,in order to avoid disputes caused by misdiagnosis,which leads to excessive diagnosis and treatment;in terms of institutional system,it is mainly the medical treatment The insurance expense is approved in the way of"historical model".Medical institutions at all levels hope to exceed a part every year to pave the way for the next year’s budget.The problem of service provider is mainly the personal interest seeking behavior of doctors with prescription right.The service object is mainly because the medical insurance has no restriction on the service object.CONCLUSION The unreasonable increase of medical insurance cost is a multi factor problem.To control the unreasonable increase of medical insurance cost,it needs to perfect the top-level design,solve the system problems,improve the treatment of doctors,and put an end to the profit seeking behavior of doctors,change the medical behavior of patients,and establish a good and effective medical order.At the same time,it needs to learn from and implement the model of foreign family doctors to manage medical insurance cost.By combining the right to sign a contract with the right to use the fund,the family doctors manage the disease and control the cost through measures such as forcing the first diagnosis in the community,two-way referral between general practice and specialty.
作者
蔡利强
杜兆辉
张胜冰
CAI Li-qiang;DU Zhao-hui;ZHANG Sheng-bing(Shanghai Pudong New District Community Health Services Center,Shanghai,201311,China)
出处
《中国初级卫生保健》
2020年第3期32-34,共3页
Chinese Primary Health Care
基金
上海市卫生计生系统优秀学科带头人项目(2017BR053)
浦东新区卫生系统领先人才项目(PWRl2016-03)
浦东新区卫生系统重要薄弱学科项目(PWZbr2017-07)。
关键词
鱼骨图模
医疗费用
不合理增长
对策研究
fishbone model
medical expenses
unreasonable growth
countermeasure and research
