医疗保险预付费方式与公立医院体制机制改革  

Studying on the relationship between prepayment of medical insurance and reform on public hospitals

作　　者：赵云[1] 叶靖[1] 

机构地区：[1]右江民族医学院,广西百色533000

出　　处：《中国卫生事业管理》2015年第6期408-412,共5页Chinese Health Service Management

基　　金：国家自然科学基金项目"基层医疗体制机制与医疗保险付费方式的适配性研究"(编号:71463060);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"(编号:13YJCZH271);广西高等学校人文社会科学研究项目"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"(编号:SK13YB074)

摘　　要：以花钱办事为视角,本文分析了医疗保险预付费方式和公立医院体制机制的分工关系。要让公立医院既控制医疗费用又保障医疗质量,关键在于构建一种合理的花钱办事机制。预付费方式下的法人治理体制机制是公立医院"花自己钱和办自己事"的根本制度。以功能协同为视角,本文分析了医疗保险预付费方式和公立医院体制机制的协同关系。一方面,公立医院的法人体制可以发挥预付费方式控费的功能优势,治理机制可以弥补预付费方式降质的功能缺陷。另一方面,预付费方式控费的功能优势可以推动公立医院法人体制构建,降质的功能缺陷可以推动公立医院治理机制构建。The relationship between prepayment of medical insurance and reform on public hospitals was analyzed. To ensure the public hospitals controlling medical expenses while guaranteeing medical quality, it is important to establish a reasonable mech- anism. In prepaid mode and corporate governance mechanism, public hospitals always spend their own money and do their own working. The collaborative relationship between prepayment of medical insurance and public hospitals＇ system was analyzed. On the one hand, the corporate governance mechanism of public hospitals can take advantage of the function of controlling expenses of prepaid mode, and make up its functional defect. On the other hand, the functional advantage of controlling expenses of prepaid mode can promote the construction of public hospitals＇ corporate governance system.

关 键 词：医疗保险 预付费方式 公立医院 体制机制 

分 类 号：R197.1[医药卫生—卫生事业管理]