美国医疗照顾计划经办服务和监管体系述评和启示
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摘要
当前经办体系能力不足已成为制约医疗保障制度发展的重要短板。但是,经办体系改革是一个综合性复杂改革,既涉及医疗服务市场改革的约束,也涉及到与监督执法机构的联动。本文通过剖析美国医疗照顾计划(Medicare)经办管理和监管体系,期望对我国改革医保经办体系、完善监督支付体系提供有益借鉴。
At present, the inadequate capacity of the management system has become an important shortcoming restricting the development of the medical security system. However, the reform of the management system is a comprehensive and complex reform, which involves not only the restraint of the reform of the medical service market, but also the linkage with the supervision and law enforcement agencies. This paper analyses the management and supervision system of Medicare Program in the United States, hoping to provide useful reference for the reform of medical insurance management system and the improvement of supervision and payment system in China.
At present, the inadequate capacity of the management system has become an important shortcoming restricting the development of the medical security system. However, the reform of the management system is a comprehensive and complex reform, which involves not only the restraint of the reform of the medical service market, but also the linkage with the supervision and law enforcement agencies. This paper analyses the management and supervision system of Medicare Program in the United States, hoping to provide useful reference for the reform of medical insurance management system and the improvement of supervision and payment system in China.
引文
[1]Centers for Medicare and Medicaid Services.Medicare Contracting Reform:Medicare's New Administrative Contractor Jurisdiction s[R/OL].http://www.cms.hhs.gov/MedicareContractingReform/Downloads/mac_jurisdiction_facts.pdf,2006-01-16/2019-1-24
[2]Foote S B. The Impact of the Medicare Modernization Act's Contracts Reform on Feefor-Service Medicare[J]. Louis UJ Health L.&Pol'y, 2007, 1:67.
[3]Centers for Medicare and Medicaid Services.Medicare Contracting Reform:Medicare's New Administrative Contractor Jurisdictions[R]. 2005.
[2]Foote S B. The Impact of the Medicare Modernization Act's Contracts Reform on Feefor-Service Medicare[J]. Louis UJ Health L.&Pol'y, 2007, 1:67.
[3]Centers for Medicare and Medicaid Services.Medicare Contracting Reform:Medicare's New Administrative Contractor Jurisdictions[R]. 2005.