利益相关者视角下总额预付制在紧密型县域医共体中实现策略研究  

Research on the Realization Strategy of the Total Prepaid System in the Close County Medical Community from the Perspective of Stakeholders

作　　者：单莹 赵洋[1,2] 李士雪 SHAN Ying;ZHAO Yang;LI Shixue(不详;Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine,Shandong University,Jinan,250012,China)

机构地区：[1]山东大学齐鲁医学院公共卫生学院卫生管理与政策研究中心,山东济南250012 [2]国家卫生健康委员会卫生经济与政策研究重点实验室(山东大学),山东济南250012

出　　处：《中国社会医学杂志》2023年第2期129-132,共4页Chinese Journal of Social Medicine

摘　　要：目的基于利益相关者理论探讨县域医共体总额预付制改革的动力和阻碍因素,探索医保支付方式改革的实施策略。方法对卫生行政部门、医保部门、医疗机构、医务人员、患者等共75名利益相关者开展访谈,构建利益相关者矩阵并进行动力与阻力分析。结果通过分析发现,卫生行政部门重视程度是推动总额预付制改革的关键因素,患者对于便捷优质医疗服务和节省医疗费用的需求是改革的动力因素。医保部门重视程度不足、预付资金测算方法不尽合理;医疗机构经费不能满足发展需求,资源配置不合理,服务质量难以保证;医务人员积极性有待提升可能是阻碍医保支付改革的潜在因素。结论卫生健康行政部门应进一步提高重视程度;医保部门应调整细化测算方式、加强监督考核、推动差异化支付;从完善激励措施和创新管理理念入手,提高医疗机构和医务人员积极性;创新运行机制,充分协同各利益相关方,切实构建“利益共同体”。Objective Based on the stakeholder theory,this study aimed to explore the impetus and obstacles of the reform of the total prepaid system of the county medical community,and to explore the implementation strategy of the reform of the medical insurance payment method.Methods A total of 75 stakeholders,including health administrative departments,medical insurance departments,medical institutions,medical staff,and patients,were interviewed to construct a stakeholder matrix and analyze their motivation and resistance.Results This study found that the health administration's attention was the key factor in promoting the reform of the total prepaid system.The patient's demand for convenient and high-quality medical services and saving medical expenses was the driving force of the reform factor.Insufficient attention paid by the medical insurance department,unreasonable methods for calculating prepaid funds,medical institution funding cannot meet development needs,resource allocation is unreasonable,service quality cannot be guaranteed,and the enthusiasm of medical staff needs to be improved were potential factors that may hinder medical insurance payment reform.Conclusion Health administrative departments should further increase their attention.Medical insurance departments should adjust and refine measurement methods,strengthen supervision and assessment,and promote differentiated payments.The enthusiasm of medical institutions and medical personnel should be increased by improving incentive measures and innovating management concepts.Operating mechanisms should be innovated and all stakeholders should be fully cooperated to effectively build a"community of interests".

关 键 词：总额预付制 医保支付方式 改革 紧密型县域医共体 利益相关者 

分 类 号：R197.1[医药卫生—卫生事业管理]