全民医保下经办模式转型升级的思考  

Reflections on the Universal Medical Insurance Management Model Transformation and Upgrading

作　　者：严娟[1] 

机构地区：[1]江苏省医疗保险基金管理中心,南京210003

出　　处：《中国医疗保险》2013年第9期30-32,共3页China Health Insurance

摘　　要：全民医保下的经办管理任务更加艰巨繁重,对经办管理能力提出更新更高的要求。但经办管理职能转变迟缓,去行政化面临阻力,机构层级特征模糊,经办能力不足。医保经办机构亟待从"事务经办型"向"能力升级型"转变,由行政性角色向参保人的代理人、医疗服务的团购者转变,赋予经办机构谈判权、签约权和购买权;实行管办分开,走法人化道路,提升职业化程度。创新组织管理形式,探索实行垂直管理。The management tasks of the universal medical insurance are more arduous and onerous, and put forward newer and higher requirements on the management capacity. But the transition of management functions is slow, the de-administration faces resistance, the hierarchical characteristics of medical insurance agencies is fuzzy, the handling capacity is insufficient, those all need the medical insurance agencies to transfrom from the ＂transaction management model＂ into＂ capacity upgrade model＂, need their roles transfer from the administrator to the insured person＇s agent and medical service group purchaser. The medical insurance agencies should be given the right of bargaining, the right of signing and the right of purchasing, implementing the separation of management and operation, taking corporation road, improving the professionalism degree. We should take innovative forms of organization and management and explore the implementation of the vertical management system.

关 键 词：医疗保险 经办管理 转型升级 思考 

分 类 号：F842.6[经济管理—保险]