管理式医疗商业健康保险探究

当前我国商业健康保险的发展速度很快，但是却遭遇了道德风险的瓶颈，保险人难以控制医疗费用的高速上涨．国外尤其是美国所实行的管理式医疗较好地缓解了这个问题，美国管理式医疗保险对于我国有很强的借鉴意义。在条件合适的情况下，我国应逐步修改相关法律条文，消除管理式医疗的制度性障碍；政府对于管理式医疗组织要给予一定的财政、税收政策优惠；加强政府的监管力度，避免出现医疗机构与保险人侵害投保人利益的事件；建立一种完善的健康信息系统及其管理系统；通过开展预防保健服务和健康教育来控制费用；通过选择医疗服务提供者和对医疗服务使用的审核来控制费用。

The rapid development of commercial health insurance business in China has encountered the bottleneck of moral risk and the insurers have difficulty to curb continuous rising of medical expenses. The managed medical system in foreign countries especially in the United States offers a solution to wind down this problem. When the situations allow, China should amend some of the relevant policies and laws to remove policy barriers to the application of managed medical care system. The government should provide certain fiscal and taxation incentives to managed medical care providers. It should also tighten up supervision to avoid damaging the interests of the applicant by the medical provider or the insured person. A complete health information system and management system should be established and preventive services and health education should be stepped up to control medical expenditure. Medical expenses can be properly controlled by choosing appropriate medical service providers and regular screening of the usage of medical services.