政府规制、标尺竞争与医保支付方式改革  

Government Regulation,Yardstick Competition and Medical Insurance Payment Method Reform

作　　者：李乐乐 俞乔 Li Lele;Yu Qiao(School of Labor and Human Resources,Renmin University of China,Beijing 100872;School of Public Administration,Sichuan University,Chengdu 610065;Institute of 21st Century Development,Tsinghua University,Beijing 100084)

机构地区：[1]中国人民大学劳动人事学院,北京100872 [2]四川大学公共管理学院,成都610065 [3]清华大学21世纪发展研究院,北京100084

出　　处：《中国行政管理》2022年第10期90-98,共9页Chinese Public Administration

基　　金：国家自然科学基金青年科学基金项目“标尺竞争机制、DRG/DIP支付方式改革与医疗服务定价”(编号:72204251);国家社会科学基金重大项目“医保费用分配及监控的大数据研究”(编号:14ZDB149)。

摘　　要：本文依据政府规制与标尺竞争理论提出分析框架,并结合开展医保支付方式改革的两个典型试点城市进行比较案例研究。本文发现,医保支付方式改革通过补偿方法和奖惩规制构建规制性标尺,通过比较成本和激励竞争构建调整性标尺;在政府规制与标尺竞争的综合作用下,形成了相对合理的医疗服务定价。医保支付方式改革的内在逻辑是通过规制性标尺和调整性标尺规避医疗提供方的信息寻租并建立医保当局、医疗机构与患者的公共契约,从而缓解信息不对称的医疗服务定价困局,促使医保资源配置趋于帕累托次优改进。本研究的价值在于:拓展了政府规制与标尺竞争理论在医保支付方式改革的应用;从改进政府管理的视角,将传统的价格管制方法扩展为信息租金激励和成本控制相容的范式。在实践中,这一研究对全国各地深入开展医保支付改革具有借鉴意义。Based on the theory of government regulation and yardstick competition,this paper puts forward an analysis framework,and makes a comparative case study of two typical pilot cities that carry out the medical insurance payment method reform.This paper finds that the medical insurance payment method reform builds a regulatory yardstick through compensation methods and reward and punishment regulations,and builds an adjustment yardstick by comparing costs and encouraging competition.Under the comprehensive effect of government regulation and yardstick competition,relatively reasonable medical service pricing has been formed.The internal logic of the medical insurance payment method reform is to avoid the information rent-seeking of medical providers through regulatory yardsticks and adjustable yardsticks,and establish a public contract between medical insurance authorities,medical institutions and patients,so as to alleviate the pricing dilemma of medical services with asymmetric information and promote the Pareto suboptimal improvement of medical insurance resource allocation.The value of this study lies in:it expands the application of government regulation and yardstick competition theory in the medical insurance payment method reform,extends the traditional price control method to the path of information rent incentive and cost control,and has reference significance for the further development of medical insurance payment reform throughout the country.

关 键 词：政府规制 标尺竞争 信息不对称 医保支付方式改革 医疗服务定价 

分 类 号：D035[政治法律—政治学]