关于社会保险承办机构增能的新思考

New reflection on enhancing the functions of the social insurance operation agencies from the new angle

在欧洲各国的医疗保险制度改革中,有一种新的改革设计方案———“管理下的竞争”(managed competi-tion)方案被看好。这套方案主要是在基本医疗保险制度中引入市场原理。它不期待社会保险承办机构和医疗机构从“善意”出发来保护患者利益。而是设计一种制度,促使医疗保险承办机构为患者的利益而行动,这也是一种带有动力机制的制度,促使医疗机构提供既有效率、又有效果的医疗服务。本文在介绍管理下的竞争这一改革方案的同时,分析我国医疗保障制度的不足,提出改革建议。

In European countries,during the reform of the medical insurance system,there is a new design of the reform program named the managed competition which has been put more attention to.This program is to introduce market principles into the basic medical insurance system.It is not prospected that the medical insurance operation agencies and the medical institutions will protect the interests of the patients from the perspective of goodwill.So,on the contrary,this reform program promotes the medical insurance operation agencies acting in the interests of the patients by designing a system which has the dynamic mechanism.The managed competition can promote the medical institutions to provide some efficient and effective medical services.This paper introduces the project of the managed competition.Meanwhile,it also analyzes the insufficient aspects of the Chinese medical security system,then offers some reformational suggestions.