How does Pricing Mechanism Affect Health Service Price:A Case Study of U.S. Health Insurance
-
摘要: 从分析价格形成的三种基本机制入手,对美国不同的医保项目的支付方式进行分类研究,特别是对其定价机制进行了研究,得出了两点结论:美国以支付方式为纽带,通过服务购买谈判方式进行医疗服务定价;医院则依据购买者议价能力,采用不同定价策略,从而形成了支付价格。因而得出:协商谈判在未来是中国医疗服务价格形成的一个重要机制,同时,应改进支付标准的形成机制和建立适合价格谈判的政策环境。Abstract: This paper analyzes three basic mechanisms of price formation, payment methods of different medical insurance schemes in America, especially the pricing mechanism. There are two conclusions: the price is formed by the bargaining between purchaser and providers, and hospitals adopt different strategies based on their bargaining power. The article considers that the negotiation is an important mechanism for the formation of China's medical service price in future; at the same time, we should improve the formation mechanism of payment standard and establish the policy environment for the price negotiation.
-
Keywords:
- purchasing mechanism /
- health service price /
- health insurance /
- price bargaining /
- America /
- healthcare reform
-
-
[1] 贲慧. 对完善公立医院补偿机制的探讨[J]. 江苏卫生事业管理, 2010,21(6):113-116. [2] 李丽.医疗服务市场政府规制研究述评[J].产业经济研究,2006(5):71-77. [3] PAUL D.17 million more Americans have coverage under ACA: RAND study[EB/OL]. (2015-05-06) [2015-11-30].
[4] MEARA E,WHITE C,CUTLER D M. Trends in medical spending by age, 1963-2000[J]. Health Affairs,2004,23(4): 176-183.
[5] FRANKFORD D M. Medicare DRGs: Efficiency and organizational rationality [J]. Yale Journal on Regulation , 1993,10: 273.
[6] HAREWOOD G C, WIERSEMA M J, EDELL E S, et al. Cost-minimization analysis of alternative diagnostic approaches in a modeled patient with non-small cell lung cancer and subcarinal lymphadenopathy[J].Mayo Clinic Proceedings, 2002, 77(2): 155-164.
[7] ANDERSON G F. From "soak the rich"to "soak the poor":Recent trends in hospital pricing[J]. Health Affairs,2007,26(3): 780-789.
[8] DOBSON A,DAVANZO J,SEN N. The cost-shift payment "hydraulic":Foundation,history,and implications[J]. Health Affairs,2006,25(1): 22-33.
[9] SMITH J C,CARLA M. Health insurance coverage in the United States: 2014, current population reports[R]. Washington, D.C.:Government Printing Office,2015:60-253.
[10] SHI L Y,SINGH D A. Delivering health care in america: A systems approach [M]. 5th ed. Sudbury, MA:Jones and Bartlett Publishers, Inc., 2012:634.
[11] HADLEY J,FEDER J. Hospital cost shifting and care for the uninsured[J]. Health Affairs,1985,4(3): 67-80.
[12] SLOAN F A. Not-for-profit ownership and hospital behavior[J]. Handbook of Health Economics,2000(1):1141-1174.
[13] MORRISEY A M. Cost shifting in health care: separating evidence from rhetoric[M].Washington,D.C.:AEI Press,1994:11-21.
[14] BURT C W,MCCAIG L F.Trends in hospital emergency department utilization:united states,1992-99[J].Vital & Health statistics,2001,13(150):1-34.
[15] AUSTIN D A, Hungerford T L. The market structure of the health insurance industry[C]//Congressional Research Service, Library of Congress, 2009:1-60.
[16] KSISER P. Kaiser permanente 2014 annual report[EB/OL]. [2016-01-14].
[17] American Hospital Association.Fast facts on US hospitals[EB/OL]. [2016-01-17].
计量
- 文章访问数: 772
- HTML全文浏览量: 51
- PDF下载量: 368