社会医疗保险监管组织体系的国际比较与借鉴  

Comparison and Reference of International Social Medical Insurance Regulation Institution Systems

作　　者：李诗晴[1] 褚福灵[1] LI Shiqing CHU Fuling

机构地区：[1]中央财经大学保险学院,北京100081

出　　处：《社会保障研究》2017年第5期78-86,共9页Social Security Studies

基　　金：2014年度国家社会科学基金重大项目"医保费用科学分配及有效监控的技术方法研究"(14AZD117)成果

摘　　要：德国、美国、英国的社会医疗保险监管组织体系经过多年的发展演变,已形成包括政府监管、非政府机构监管、专业组织监管等在内的多层次的监管体系。我国社会医疗保险监管组织体系仅由政府监管作为主要监管机构,亟待完善。本文认为,应当借鉴德国法定医疗保险(Statutory Health Insurance)、美国老年人社会医疗保险(Medicare)、英国国民健康服务(National Health Service,NHS)的监管组织框架、监管内容及监管方式,加强我国医疗保险政府主管部门在社会医疗保险相关法律政策制定方面的职责,设立专门的社会医疗保险监管机构进行独立监管,成立专业机构开展辅助监管,建立社会医疗保险诉讼处理机构以完善诉讼机制。After developing for several y e a r s, social medical insurance regulation institution systems in Germany, the United States and the United Kingdom have formed multi - level systems including government regulation, non - government regulation and professional agency regulation. However, social medical regulation in China consists of only government a s main regulation institution. This article concludes that our country should learn from Statutory Health Insurance of Germany, Medicare of the United States and National Health Service of the United Kingdom, and improve social medical insurance regulation institution system in China by enhancing the policy - making responsibilities of governments and setting up specialized social medical insurance regulation institution, professional regulation agencies a s well a s social medical insurance lawsuit mediation institution.

关 键 词：社会医疗保险 监管组织体系 比较与借鉴 

分 类 号：F841.3[经济管理—保险]