美国医保经办管理费用水平探究  

Research on the Medical Insurance Management Expenses in the United States and Its Enlightenment

作　　者：吕兰婷 王知 

机构地区：[1]中国人民大学公共管理学院,北京100872 [2]中国人民大学卫生技术评估与医药政策研究中心,北京100872

出　　处：《中国医疗保险》2023年第2期59-63,共5页China Health Insurance

基　　金：国家医疗保障局“医疗保障宏观筹资负担比较研究”(2021001);国家社会科学基金青年项目“社会医疗保险‘新卑斯麦’改革模式的国际比较研究”(18CSH060)。

摘　　要：美国作为商业医疗保险体系发展较为成熟的典型国家,其医保管理费用能够较好地反映商业保险公司经办效率情况。本文基于对美国各类医保项目管理费用相关数据的整合统计,分析总结商业保险公司管理费用水平特点和原因,以期为我国合理设计医保经办管理费用投入、完善医疗保险经办管理服务体系建设提供一些实践信息参考。As a typical country with a mature commercial medical insurance system, the United States’ medical insurance management costs can better reflect the efficiency of commercial insurance companies. Based on the integrated statistics of the data related to the management costs of various medical insurance projects in the United States, this paper analyzes and summarizes the characteristics and reasons of the level of management costs of commercial insurance companies, with a view to providing some practical information for China to reasonably design the investment of medical insurance management costs and improve the construction of medical insurance management service system.

关 键 词：医疗保险 医疗保障模式 美国 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]