医保付费机制改革障碍的经济学分析

Economic Analysis on the Obstacles to the Medical Insurance Payment Mechanism Reform

目的:为推动我国医保付费机制改革提供政策建议。方法:以需方和供方同时展开竞争为视角,以提高医保服务效率和医保费用管理效率为目标。结果:医保付费机制改革障碍的原因是行政化思维模式,医疗市场主体缺位,付费机制改革制度扭曲以及医保经办机构行政垄断。结论:应从公立医院去行政化,鼓励社会资本进入参与竞争,医疗机构补偿机制改革以及医保经办机构的法人治理变革4个方面推动医保付费机制改革。

Objective:To provide policy recommendations for promoting the reform of medical insurance payment mechanism.Methods:Based on the perspective that purchasers and providers should all be involved in market competition, improving the efficien-cy of medical services and medical insurance expenditure management were set as the aim.Results:The reason for obstacles of medi-cal insurance payment can be attributed to administrativization, absence of participants in medical market, distortion in payment mech-anism reform, distorted payment mechanism reform system and monopolization by medical insurance agencies.Conclusion:To pushmedical insurance payment mechanism forward, it needed to get rid of administration in public hospitals, absorb private capital, re-form payment mechanism for public hospitals and corporate governance for medical insurance agencies.