合约理论下医疗保险支付制度分析  

The Analysis of Health Care Payment under Contract Theory

作　　者：刘祯祯[1] 常峰[1] 

机构地区：[1]中国药科大学国际医药商学院,江苏南京211198

出　　处：《中国卫生质量管理》2011年第4期84-86,共3页Chinese Health Quality Management

摘　　要：医疗保险支付是保险机构同医疗服务供方订立合同,购买医疗服务的过程。保险机构希望通过合同对供方行为进行激励从而控制医疗成本。以合约理论为分析工具,对现行医疗保险支付方式进行分析,并对后付制和预付制两种支付机制的效果进行比较。提出,为了在保证医疗服务质量的同时达到费用控制的目的,单一的支付方式未必能取得良好的效果,医疗保险机构应综合利用两种支付机制的优势,达到对医疗服务供方行为监督的目的。Health care payment is the contract achieved between health care insurance and health care provider, which is used by health insurance to purchase health care service. The function of payment contract is to motivate health care provider to provide high quality service at the same time control the service cost. We intend to use contract theory to analysis payment method implemented at the present time. We also conpare different effects result from two different payment methods （FFS and prospective payment）. Finally, in order to motivate providers behavior, single payment method could not achieve desired effect, thus health insurance should take advantages of both payment methods, to provide high quality health care as well as controllable cost.

关 键 词：合约理论 支付制度 费用控制 

分 类 号：R197.3[医药卫生—卫生事业管理]