卫生行政部门参与医疗保险资金管理模式的探索与推广  

The exploration and practice of the health authority managerial involvement of the medical insurance fund

作　　者：陈英耀[1] 黄葭燕[1] 韩鹏[1] 田丹[1] 顾而洲[1] 

机构地区：[1]复旦大学公共卫生学院,上海200032

出　　处：《中国卫生政策研究》2010年第6期27-32,共6页Chinese Journal of Health Policy

基　　金：卫生部政策法规司资助课题

摘　　要：以A市为例,分析了医疗保险资金管理模式的特点,结合该管理模式的形成过程和运行机制,从内在矛盾、外在诱因、关键人物、意见共识、协调平台和协调机制分析了模式形成的影响因素,对该模式是否具有一定的推广价值进行了可行性分析。研究认为该管理模式具有一定的推广价值,并提出政策建议:积极发挥卫生行政部门的作用,强化医疗保险资金管理;有效建立与医保相关的多部门协调平台与机制;尝试隶属卫生部门的医疗保险结算中心新模式的更多试点。This paper described the medical insurance fund management model in A city,analyzed the influencing factors for the medical insurance fund management model based on evidences of how it developed and how it worked. In addition,it was deliberated from the inner contradiction,the external predisposing factor,key stakeholders,common senses,and the coordinating platform or mechanism. Furthermore,it explored the likelihood of whether such a management model could be generalized to other cities,and suggest it be of generalization to some extent. Policy recommendations were proposed,including to strengthen medical insurance fund management by the involvement of health authority,to establish the coordination mechanism by multiple stakeholders,and to conduct more pilots of such a model.

关 键 词：医疗保险 资金 管理模式 影响因素 推广 

分 类 号：R197[医药卫生—卫生事业管理]