中国医疗保险经办机制:现状评估与未来展望  

The Management Mechanism for China’s Social Health Insurance: Evaluation and Outlook

作　　者：华颖[1] HUA Ying(Institute of Population and Labor Economics,Chinese Academy of Social Sciences,Beijing 100732,China)

机构地区：[1]中国社会科学院人口与劳动经济研究所,北京100732

出　　处：《西北大学学报（哲学社会科学版）》2020年第3期157-166,共10页Journal of Northwest University：Philosophy and Social Sciences Edition

基　　金：国家社会科学基金特别委托重大项目“中国社会法系列研究”(18@ZH023)。

摘　　要：中国医保改革已进入全面深化阶段,医保行政管理体制已经统一,优化制度的顶层设计亦已出台,但医保经办机制改革的滞后及其日益显性化的不良效应,正在成为影响医保制度健康发展的重大因素。因此,宜将完善医保经办机制作为医保治理现代化的关键内容,列入新时期深化医保改革的优先项,加快实现医保经办机制的统一,最终实现医保经办机构独立法人化、经办经费来自医保基金以及经办机构与医药机构之间的集体有序谈判协商的目标模式,为医疗保险制度的高效实施提供稳健保障。China is deepening all aspects of its health insurance reforms. With this background and the unification of the government’s health insurance administration and the finalization of its overarching design to improve health insurance, delayed reform of the health insurance management mechanism and its increasingly prominent adverse effects are posing challenges to the healthy development of the health insurance system. Thus, it is advisable to prioritize the reform and unification of the health insurance management mechanism, which is a key step to modernizing the health insurance governance and guaranteeing the efficient implementation of the health insurance system. The target model involves health insurance agencies(insurers) that are independent legal entities which draw their administrative fees from the insurance fund, while health insurance agencies and health care providers conduct collective and well-organized negotiations.

关 键 词：医疗保险经办 现状评估 改革方案 

分 类 号：C912.2[经济管理]