文档介绍：摘要
本文着眼于现实医疗市场中医疗机构对患者基本医疗保险参保身份的关注大
量人群有病不敢看和部分人投机取巧浪费卫生资源同时并存的现象选取武汉市一
家医保定点医院两个专业科室的主要病种考察其在某一时间段内所有住院病人的费
用清单和病历从诊疗行为的结果角度对参保病人和非参保病人进行对比统计分析
旨在发现在基本医疗保险制度下被排除在制度外的人群在医疗服务的可及可得
方面特别是医疗费用负担状况与参保人群相比是否不公平两群体医疗需求满足
情况如何以及在武汉市现行的基本医疗保险政策下诊疗行为中存在哪些道德风险
笔者希望针对这些问题的解决提出一些应对措施和大家探讨
文章首先是导论部分结合生活中的现象提出问题陈述了研究目的和意义综
述了现有的相关研究并介绍了一些相关概念和背景特别是武汉市的基本医疗保险
政策这是下一步对比分析的政策框架然后笔者专门介绍了本文的研究思路和方法
包括病种选取和指标选取
其次是对诊疗行为的考察分析笔者借助一些图表和描述性分析证明了非参保
群体与参保群体相比的确在医疗服务可及可得上特别是经济负担方面存在不公平
且现在医疗负担的压力已使得大多数患者的医疗需求遭到了抑制另外在武汉市基
本医疗保险政策下诊疗行为中的道德风险表现为分解住院小病大养和住
院赚钱等
再次笔者指出了本研究的基本结论和不足
最后文章针对这些结论给予了一系列应对措施
关键词基本医疗保险制度诊疗行为医疗服务公平性道德风险
III
Abstract
This paper is interested in the following phenomenon: the medical frameworks pay
attention to if the patient has taken part in the Basic Medical Insurance System; A lot of
people have so many miseries in the medical fees, but at the same time, always a few
people waste the limited medical resources. In order to clarify the essence of these
phenomenon: people excluded by the Basic Medical Insurance System have obtained the
medical service unfairly, compared with the beneficial people, the medical service for them
are less in quantity and quality. Besides, most of the patients have so heavy burden in
medical fees that some reasonable medical demands have restrained, and the deep reason
for them is the universality of “moral hazard” in medical market. The author chooses two
diseases in one Basic Medical Insurance special hospital, and collects all patients’
information, including the whole statements of accounts and case histories. Then analyze
the two colonies contrastively.
The paper begins with indications of hospitalization problems in our general life,
discusses the relevant studies. Then introduces some primary concepts and policy
background in Wuhan, because this is the context of the following analysis. Afterward, the
author specially narrates the analytic mode, explains why choose the