北京航空航天大学学报(社会科学版) ›› 2008, Vol. 21 ›› Issue (1): 40-42.

• 公共管理 • 上一篇    下一篇

关于按服务项目支付的探讨

高庆波   

  1. 中国人民大学 劳动人事学院, 北京 100872
  • 收稿日期:2006-05-08 出版日期:2008-03-25 发布日期:2010-05-18
  • 作者简介:高庆波(1975-),男,吉林舒兰人,博士研究生,研究方向 为社会保障.

Pay on Fee in China

GAO Qing-bo   

  1. School of Labor and Human Resources, Renmin University of China, Beiji ng 100872, China
  • Received:2006-05-08 Online:2008-03-25 Published:2010-05-18

摘要:

按服务项目支付是中国医疗保险实践广泛采用的结算方式。文章分析了在医疗保险中医院、 患者、医疗保险经办机构各自的目标、行为以及在不同的报销模式下的行为选择,并进一步 得出,医疗保险经办机构采用不同的报销模式将导致不同的主体间关系、不同的医疗保险满 意度以及医疗资源利用水平。中国医疗保险事业缺乏西方国家成熟的商业保险行业组织以及 相应的经验和信息积累,变更医院的目标函数和约束条件是更加合理地利用医疗资源的关键 。

关键词: 医疗保险, 按服务项目支付, 行为分析

Abstract:

Pay on fee is a widely used way of settlement in the medical security system of China. This paper analyzes the objectives and action choices under dif ferent reimbursement patterns taken by hospitals, patients and medical security organizations. Further analysis shows that different reimbursement patterns take n by the medical security organizations will lead to different interrelationship s, different satisfied degrees and utilization levels of medical resources. Lack of business insurance organizations and management experience and information a ccumulation, the settlement way of pay on fee in China has to be used for a long time. The key to utilize medical resources more properly is to modify object fu nctions and constraint conditions of hospitals.

Key words: medical security, pay on fee, action analysis

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