“管理式医疗”机制:美国经验与我国借鉴  

On the Managed Care Mechanism of U.S.: Theories and Experiences

作　　者：张涛[1] 袁伦渠[1] 

机构地区：[1]北京交通大学经济管理学院,北京100044

出　　处：《河南社会科学》2013年第6期28-32,107,共5页Henan Social Sciences

基　　金：2009年国务院参事室项目"中美医疗保障运行机制研究"(B08L0410)

摘　　要：美国的"管理式医疗"机制在全球医疗保障领域独树一帜。"管理式医疗"的实质,在于医保机构从游离于医患关系之外的被动赔付者转变为介入医患关系的"第三方",通过一体化医疗服务网络、预付费制度、医疗服务管理、健康管理等契约安排或管理手段,克服医患关系中的市场失灵,解决医疗费用和质量问题。要破解医疗体制改革的困局,从根本上缓解"看病贵、看病难"问题,我国需要在明确医保部门、卫生部门和医疗机构的分工定位,加强人才、软件、硬件三个方面的基础设施建设的基础上,借鉴"管理式医疗"的先进经验,完善医疗保障运行机制。The managed care mechanism of U.S. is quite special among the global health care systems. The essences of managed care is that the health insurer acts as the third party between the medical providers and enrollees, by exerting a series of contractual arrangements and management tools, in order to overcome the market failures between the providers and enrollees, and hence solve the cost and access problems of health care system. In order to overcome the difficulties of health care reform here in China, we should introduce the advanced experiences of managed care to improve the operation mechanism of health care system, based on optimizing the rights and responsibilities of medical administration departments, health insurance administration departments and medical providers, and improve the infrastructure in terms of hardware, software and human resources.

关 键 词：医疗保障 管理式医疗 医疗体制改革 

分 类 号：C93[经济管理—管理学]