医疗保险预付费方式下医疗质量风险的治理机制  

Governance mechanism of medical quality risk under prepaid mode of medical insurance

作　　者：赵云[1] 

机构地区：[1]右江民族医学院公共卫生与管理学院,广西百色市城乡路98号533000

出　　处：《中国医院》2014年第1期66-69,共4页Chinese Hospitals

基　　金：教育部人文社会科学研究项目"公立医院体制机制与医疗保险付费方式的适配性研究"(13YJCZH271);广西高等学校人文社会科学研究项目"广西县级公立医院长效补偿机制的创构:基于医疗保险付费制度的研究"(SK13YB074)

摘　　要：医疗保险预付费方式是控制医疗费用的有效手段,也是制造医疗风险的罪魁祸首。所以,采取医疗保险预付费方式的过程,也是防范医疗质量风险的过程。先从"多"和"少"的角度分析医疗保险预付费方式下医疗质量风险的主要形式,再从经营模式和激励机制的角度阐述医疗保险预付费方式下医疗质量风险的形成机理,后从责权利均衡的角度提出医疗保险预付费方式下医疗质量风险的治理机制。Medical insurance prepaid system is the ef ective measure to control medical costs, but also the culprit to reduce the medical risk. Taking care of prepaid mode, is also the process of preventing the medical quality risks. Firstly, the paper analyzes the main form of medical quality risk under prepaid mode of medical insurance from the perspective of＂more＂and＂less＂. Secondly, the paper expounds formation mechanism of medical quality risk under the medical insurance prepaid mode from two aspects including management pattern and the incentive mechanism;Finally, the paper puts forward medical quality risk governance mechanism under the medical insurance prepaid mode from the perspective of equilibrium of responsibilities, rights and interests.

关 键 词：医疗保险 预付费方式 医疗质量风险 治理机制 

分 类 号：R197.1[医药卫生—卫生事业管理]