论基本医疗保险中住院医疗费用的需求方控制  

Control of In-patient Expenditures from Demand Side in the Basic Medical Insurance

作　　者：贾洪波[1] 

机构地区：[1]北京航空航天大学,北京100191

出　　处：《中国卫生经济》2012年第12期11-13,共3页Chinese Health Economics

基　　金：2009年教育部人文社会科学一般研究项目(09YJC840004);中央高校基本科研业务费项目(YWF-11-06-012)

摘　　要：目的:讨论基本医疗保险中住院医疗费用的需求方控制办法。方法:定性和定量分析基本医疗保险中住院医疗费用的需求方控制。结果:现行基本医疗保险制度是通过起付线、共保率和封顶线这3条措施来对住院医疗费用的需求方进行控制的。起付线和封顶线的设置在基本医疗保险制度的实际运行中产生了一系列弊端。它们的作用和共保率的作用有重叠之处,而且还不利于基本医疗保险基金平衡运营。结论:应该在取消起付线、封顶线和合理确定住院医疗费用共保率的基础上,以共保率为中心对住院医疗费用的需求方实施控制。Objective： To explore the methods of controlling in-patient expenditures from demand side in the basic medical insurance. Methods： Qualitative and quantitative methods are used to analyze the control of in-patient expenditures from the demand side in the basic medical insurance. Results： In-patient expenditures can be controlled by three measures, namely the deduetibleline, co-insurance rate and expenditure ceiling from demand side in the present basic medical insurance system. The deduetibleline and expenditure ceiling make many shortcomings in the practical running of basic medical insurance. The role of the deduetibleline and expenditure ceiling not only overlap the role of co-insurance rate, but also do not contribute to the balance of basic medical insurance fund. Conchusion： Co-insurance rate should play the eore role on controlling in-patient expenditures from demand side in the basic medical insuranee based on the repealing the deductible, expenditure eeiling and establishing desirably the co-insurance rate of in- patient expenditures.

关 键 词：基本医疗保险 住院医疗费用 道德风险 共保率 

分 类 号：R197.1[医药卫生—卫生事业管理]