德国医疗保障体系改革及启示  

Social health insurance reform in Germany and implications for China

作　　者：房珊杉[1] 孙纽云[1] 梁铭会[1] 

机构地区：[1]卫生部医院管理研究所,北京100191

出　　处：《中国卫生政策研究》2013年第1期28-33,共6页Chinese Journal of Health Policy

摘　　要：德国是世界上最早建立社会医疗保障制度的国家,其医疗保障体系以法定医疗保险为主,私人医疗保险为辅,基本实现了全民覆盖。本文在梳理德国医疗保障体系三次改革的基础上,阐述德国当前医保管理模式、医疗保险体系、医疗服务体系以及对弱势人群进行保障的现状特点,归纳德国医疗保障体系在发挥市场机制、医保福利包设计、提供均等医疗服务、实行家庭医生制度、注重质量和效率的具体经验,进而提出厘清政府和市场的关系、适时调整医保福利包、逐步建立分级诊疗模式、保障公平的医疗服务以及合理控制医药费用等建议。Germany was the first country to establish social health insurance system. The health insurance sys- tem in Germany is composed of compulsory social insurance and private insurance, with universal coverage. After systematically introducing three healthcare reforms, this paper analyzes present situation and characteristics of health service regulation mode, medical service system, medical insurance system and security of disadvantaged people; summarizes the experience of design of benefit package, deliver equitable services, introduce market competition mechanism, ambulatory medical care, maintaining quality and efficiencies, and then put forward some advice to pro- mote the construction work of the security system ： clarifying the relationship between the government and the market, incrementally adapting the mandated benefit package, gradually establishing the mode of referral system, supplying fair medical services and controlling medical cost reasonably.

关 键 词：社会健康保险 竞争 质量 效率 

分 类 号：R197[医药卫生—卫生事业管理]