浅析美、德医疗保险谈判机制及其对我国的启示  

Analysis on the Medical Insurance Negotiation Mechanism in America and Germany and the Implications to China

作　　者：陈继芳[1] 白丽萍[1] 赖永洪[2] 梁萍萍[1] 黄海荣[1] 

机构地区：[1]广州医科大学卫生管理学院,广东广州510182 [2]广州医科大学附属第三医院,广东广州510150

出　　处：《医学与哲学（A）》2015年第3期66-68,共3页Medicine & Philosophy:Humanistic & Social Medicine Edition

基　　金：广东省哲学社会科学"十一五"规划2010年度学科共建项目"卫生政策伦理研究:基于价值观的视角";项目编号:GD10XZX01;广州市教育科学规划课题"卫生经济学课程的教学实践与改革";项目编号:2013A092

摘　　要：医疗保险谈判机制的建立,有利于协调医、患、保三方利益,控制医疗费用和提高医疗质量。美国是医疗保险个体谈判模式的代表,可以保证服务的优质高效,但谈判成本高且制度公平性差。德国是医疗保险集体模式的代表,谈判成本低且公平性好,但制度缺少灵活性,效率也较低。我国是国家宏观调控下的个体谈判模式,能够兼顾各地经济情况和疾病地区差异,但管理碎片化、谈判主体地位不平等且谈判力量不平衡。通过比较分析,提出采用共同治理的集体谈判模式、建立多层次的谈判结构和引入竞争性的谈判主体的建议,探索我国医疗保险谈判机制的发展道路。The establishment of medical insurance negotiation mechanism is beneficial to coordinate the interests of medical insurance among hospitals, the insured and insurance agencies and control medical care cost and improve medical care quality. The individual negotiation model of medical insurance as represented in America, guarantees the quality and efficiency of services, whereas resulting in high cost of negotiation and inferior equity of system. The collective negotiation model of medical insurance as represented in Germany, shows low cost of negotiation and fine equity of system, meanwhile bringing about the inflexibility and inefficiency of system. China takes the individual negotiation model of the medical insurance under the national macroeconomic regulation and control, which is able to give consideration to the economy and disease differentiation in regional differences, while its management is fragmentation, negotiation subject status is inequality and negotiation power is imbalance. Based on compare and analysis, this article puts forward suggestions that China should adopt collective negotiation mechanism with co-governance, establish multi-level negotiating structure and introduce competitive negotiation main actors,in order to explore an effective path to develop the medical insurance negotiation mechanism in China.

关 键 词：医疗保险谈判机制 共同治理 集体谈判 

分 类 号：R197[医药卫生—卫生事业管理]