新农合定点医疗机构的不端行为及其治理  

Definition and administration of misconduct of designated medical institutions of new rural cooperative medical system

作　　者：刘雅静[1] 

机构地区：[1]山东大学马克思主义学院,山东济南250100

出　　处：《湖南农业大学学报（社会科学版）》2012年第1期39-45,51,共8页Journal of Hunan Agricultural University(Social Sciences)

基　　金：山东省社会科学规划研究项目(10BJGJ06);教育部人文社会科学研究规划项目(06JA790059);山东省教育厅立项课题(J04T51)

摘　　要：定点医疗机构的服务行为是决定新农合医疗制度可持续发展的关键。由于医疗行业的高度专业性和技术性以及参合农民医疗服务消费的乏知性、被动性、不确定性,定点医疗机构出于自身利益的考虑,往往会诱导农民的医疗需求,产生不合理化验与检查、开大处方、违规造假、收费不规范等不端行为,致使参合患者的医疗负担增加,增大合作医疗基金的风险,进而严重影响甚至制约新农合医疗制度的可持续发展。因此,必须通过独立于卫生部门的社会保障部门行使监督职能,实行指标管理,改革费用支付方式,完善内部管理、收入分配及监督制度,建立农民自治监督组织,完善农民监督员制度等治理措施,强化政府部门和参合农民的监管、监督以及定点医疗机构的内部治理,有效规范和约束定点医疗机构的诊疗、收费行为。Service behavior of designated medical institutions is a key factor that can determine the sustainable development of new rural cooperative medical care system. The medical industry＇s high professionalism and technicality suggest a serious information asymmetry between medical institutions as services-providers and farmers as beneficiaries. Out of their own interests, designated medical institutions tend to manipulate their own technical monopoly and induce farmers＇ medical needs so as to provide excessive medical services. This can not only bring an increased financial burden on participating patients for medical treatment, but also add a risk of cooperative medical care funds, thereby threaten the sustainable development of new rural cooperative medical system. Therefore, it is important to take some measures as following： have social security administrative departments supervise the designated medical institutions; establish farmers＇ autonomy monitoring organization; strengthen the supervision of government and participants as well as internal governance of medical institutions; regulate fees and charges of designated medical institutions.

关 键 词：新农合 定点医疗机构 医疗不端行为 治理措施 社会保障 农民 

分 类 号：C913.7[经济管理]