城镇职工基本医疗保险费用控制困境及对策——以N市为例
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摘要
"新医改"以来,无论是总卫生支出还是国家、居民自身为医疗服务付出的经济成本,都呈快速增长的趋势。N市城镇职工基本医疗保险费用支出增长速度居高不下,呈现出增速不合理、结构不平衡等现象,对制度长期稳定运行和可持续性发展带来了挑战。从医疗保险制度体系的保险人(医保经办机构)、被保险人(参保人员)和医疗服务提供者(定点医疗机构)三方利益主体看,费用控制面临着定点医疗机构准入与退出机制不完善、对参保人自主控费支持不足、难以激发医保经办机构控费动力等问题。为合理控制医疗保险费用支出,需要多管齐下,引入供方竞争机制,合理引导需方需求,提升保方经办能力,注重供、需、保三方措施之间的联动性和均衡性。
"The New Medical"Reform has caused the rapid growth of the expense by residents and the whole country since it was carried out.The expense of Urban Employee Basic Medical Insurance in N city is rising rapidly without control,which unreasonable growth and imbalance structure bring challenges to sustainable development.In the perspective of the interests among insurers and insured people and medical institutions,the expenses of medical care is facing a multitude of serious problems,such as the standard of geting in and out the medical care institutions being not perfect,the support of insured charge being not sufficient and it being difficult to inspire the power of control by medical institutions.In order to control the expense of medical care insurance more reasonable,we can take a variety of measures:firstly,introducing the competition between suppliers and guiding the demand-side to consume reasonable; secondly,improving the handing ability of medical institutions; thirdly,keeping the balance among the suppliers and demand-side and medical institutions
"The New Medical"Reform has caused the rapid growth of the expense by residents and the whole country since it was carried out.The expense of Urban Employee Basic Medical Insurance in N city is rising rapidly without control,which unreasonable growth and imbalance structure bring challenges to sustainable development.In the perspective of the interests among insurers and insured people and medical institutions,the expenses of medical care is facing a multitude of serious problems,such as the standard of geting in and out the medical care institutions being not perfect,the support of insured charge being not sufficient and it being difficult to inspire the power of control by medical institutions.In order to control the expense of medical care insurance more reasonable,we can take a variety of measures:firstly,introducing the competition between suppliers and guiding the demand-side to consume reasonable; secondly,improving the handing ability of medical institutions; thirdly,keeping the balance among the suppliers and demand-side and medical institutions
引文
[1]Kenneth J.Arrow.Uncertainly and the Welfare Economics of Medical Care[J].The American Economic Review,1963,(10):941-973.
[2]Pauly M.V.Nonprofit firms in medical markets[J].The American Economic Review,1987,(77):257-274.
[3]Pauly M.V.The economics of moral hazard:Comment[J].The American Economic Review,1968,(58):89-106.
[4]Mc Guire T.G.,Pauly M.V.Response to Fee Changes with Multiple Payers[J].Journal of Health Economics,1991,(10):15-32.
[5]张小莹.医疗保险经办机构对城镇职工基本医疗保险费用的控制探究[D].武汉:华中科技大学,2010.
[6]胡善联.国际医疗保险经验的借鉴[J].中国卫生经济,1997,(4):53-56.
[7]郑秉文.信息不对称与医疗保险[J].经济社会体制比较,2002,(6):8-15.
[8]赵曼,吕国营.关于社会医疗保险承保范围的分析[J].财政研究,2002,(3):14-18.
[9]吴传俭.社会医疗保险道德风险博弈与防控措施研究[J].医学与哲学:人文社会医学版,2006,(7):49-50.
[10]国锋,孙林岩.患者道德风险与医生诱导需求的影响与控制[J].中国卫生经济,2004,(7):77-78.
[11]赵曼,吕国营.社会医疗保险中的道德风险[M].北京:中国劳动社会保障出版社,2007.
[12]杨燕绥.医疗保险经办机构能力建设的目标与路径[J].中国医疗保险,2013,(9):23-26.
[13]郭士征.国外医疗保险近期发展特点和控制费用的经验[J].中国卫生经济,1998,(5):60-61.
[14]王东进.评说医保支付进言机制创新[J].中国医疗保险,2015,(4):5.
[2]Pauly M.V.Nonprofit firms in medical markets[J].The American Economic Review,1987,(77):257-274.
[3]Pauly M.V.The economics of moral hazard:Comment[J].The American Economic Review,1968,(58):89-106.
[4]Mc Guire T.G.,Pauly M.V.Response to Fee Changes with Multiple Payers[J].Journal of Health Economics,1991,(10):15-32.
[5]张小莹.医疗保险经办机构对城镇职工基本医疗保险费用的控制探究[D].武汉:华中科技大学,2010.
[6]胡善联.国际医疗保险经验的借鉴[J].中国卫生经济,1997,(4):53-56.
[7]郑秉文.信息不对称与医疗保险[J].经济社会体制比较,2002,(6):8-15.
[8]赵曼,吕国营.关于社会医疗保险承保范围的分析[J].财政研究,2002,(3):14-18.
[9]吴传俭.社会医疗保险道德风险博弈与防控措施研究[J].医学与哲学:人文社会医学版,2006,(7):49-50.
[10]国锋,孙林岩.患者道德风险与医生诱导需求的影响与控制[J].中国卫生经济,2004,(7):77-78.
[11]赵曼,吕国营.社会医疗保险中的道德风险[M].北京:中国劳动社会保障出版社,2007.
[12]杨燕绥.医疗保险经办机构能力建设的目标与路径[J].中国医疗保险,2013,(9):23-26.
[13]郭士征.国外医疗保险近期发展特点和控制费用的经验[J].中国卫生经济,1998,(5):60-61.
[14]王东进.评说医保支付进言机制创新[J].中国医疗保险,2015,(4):5.