北京航空航天大学学报(社会科学版) ›› 2018, Vol. 31 ›› Issue (4): 44-52,59.DOI: 10.13766/j.bhsk.1008-2204.2018.0107

• 公共政策与治理 • 上一篇    下一篇

基本医保基金经办机构与公立医院之应然关系——理论及其对公立医院改革的启示

贾洪波   

  1. 北京航空航天大学 社会保障研究所, 北京 100083
  • 收稿日期:2018-04-08 出版日期:2018-07-25 发布日期:2018-07-26
  • 作者简介:贾洪波(1976-),男,甘肃镇原人,副研究员,博士,研究方向为社会医疗保障.
  • 基金资助:

    2013年国家社科基金一般项目(13BZX088);2014年国家社科基金一般项目(14BRK020);2016年基本科研业务费项目(74027401)

Ideal Relation between Administrative Department of Basic Medical Insurance Fund and Public Hospital: Theory and Its Implication for Public Hospital Reform

JIA Hongbo   

  1. Institute of Social Security, Beijing University of Aeronautics and Astronautics, Beijing 100083, China
  • Received:2018-04-08 Online:2018-07-25 Published:2018-07-26

摘要:

基本医疗保险基金经办机构与公立医院之间的关系,实质上是医疗服务需求方和供给方的关系。消费者主权理论、管理型竞争理论、花钱矩阵理论,可以为理顺基本医疗保险基金经办机构与公立医院之间的应然关系提供理论依据。公立医院彻底地去行政化和赋予其独立的市场主体地位、基本医疗保险基金经办机构与公立医院就其提供的基本医疗服务进行谈判购买、基本医疗保险基金支付方式走向按绩效付费、公立医院与公立医院以及与其他非公立医疗机构之间开展市场竞争、强化医药分家后对医疗行为的行业监管、基本医疗保险基金经办机构在药品招标采购中居于主导地位、加强区域医疗资源规划、优化基本医疗保险基金经办机构管理应该成为公立医院未来改革努力的方向。

关键词: 基本医保基金经办机构, 公立医院, 消费者主权, 管理型竞争, 花钱矩阵

Abstract:

The essential relation between administrative department of basic medical insurance fund and public hospital is the relation between demand and supply of healthcare. Consumer paramountcy theory, managed (care) competition theory and cost matrix theory can be the theoretical foundation to establish ideal relation between administrative department of basic medical insurance fund and public hospital. The reform of public hospital in the future should move towards the following:public hospital should be de-administration and become independent market player, administrative department of basic medical insurance fund should purchase basic health care from public hospital by means of negotiating, the reimbursement of basic medical insurance should transform into payment for performance, the competition should be carried out among public hospital and non-public hospital, industry supervision should be strengthen after separating of medical treatment and drug sale, leading position of administrative department of basic medical insurance fund should be assured in the course of procurement tenders of drugs, regional planning of health resource should be improved and management of administrative department of basic medical insurance fund should be optimized further.

Key words: administrative department of basic medical insurance fund, public hospital, consumer paramountcy, managed (care) competition, cost matrix

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