医疗保障协商谈判机制的德国经验及借鉴  

The German Experience and Reference of Negotiation Mechanism between Medical Insurance Administrative Agencies and Medical Institutions

作　　者：顾雪非 王怡欢 李婷婷 孙杨[4] GU Xuefei;WANG Yihuan;LI Tingting;SUN Yang(National Health Development Research Center,Beijing 100044,China;不详)

机构地区：[1]国家卫生健康委卫生发展研究中心,北京100044 [2]中国兵器装备集团有限公司,北京100089 [3]滨州医学院烟台附属医院,山东烟台264100 [4]武汉大学政治与公共管理学院,湖北武汉430072

出　　处：《卫生经济研究》2024年第1期29-31,共3页

基　　金：国家医疗保障局医疗保障事业管理中心“医保经办机构与医疗机构协商谈判机制研究”(2020-6-03270);国家卫生健康委员会体制改革司“医疗医保谈判协商机制建设”(CNHDRCKJ-L-2022-92-01781)。

摘　　要：近年来,我国各地开展了一系列医疗保障协商谈判的实践与探索,在取得成绩的同时仍存在协商谈判主体之间地位、议价能力不平衡等问题,不利于医疗保障的高质量发展。德国是具有丰富的医保协商谈判经验的典型国家之一,其法定医疗保险协商谈判以社会自治为主,尽量避免政府介入,核心思路是构建力量均衡的协商谈判参与主体、确定激励相容的协商谈判内容和完善的协商谈判配套机制,为我国完善医保协商谈判机制提供了有益经验。In recent years,various regions in China have carried out a series of practices and explorations in medical security negotiation.While achievements have been made,there are still problems such as imbalanced status and bargaining power among the negotiation parties,which are not conducive to the high-quality development of healthcare insurance.The practice of healthcare insurance negotiation can be traced back to Germany,where the negotiation of statutory health insurance focuses on social autonomy and avoids government intervention as much as possible.The core idea is to establish balanced negotiation parties,determine incentive-compatible negotiation content,and establish a complete supporting mechanism for negotiation.The German practice provides useful experience for improving the healthcare insurance negotiation mechanism in China.

关 键 词：协商谈判机制 医保经办机构 医疗机构 

分 类 号：R19[医药卫生—卫生事业管理] F840.684[医药卫生—公共卫生与预防医学]