医疗保险谈判机制探析

On the medical insurance negotiation mechanism

医疗保险谈判机制是医疗服务的购买方和提供方通过对话和谈判达成协议,就医疗服务的范围、价格、质量等进行规范,以明确双方责、权、利的一种制度安排。本文对医疗保险谈判机制的理论基础进行了剖析,明确了医疗保险谈判机制的制度框架;对医疗保险谈判机制的国际经验进行了总结,划分了医疗保险谈判机制的基本模式;对我国医疗保险谈判机制探索实践中的现实困境进行了分析,目的在于寻求我国医疗保险谈判机制的发展之道。

Medical insurance negotiation mechanism is a process to achieve agreement between medical services provider and consumer through dialogues and negotiations, setting the price and quality of medical services and lay- ing down bilateral responsibilities, rights and benefits. The establishment of a negotiation mechanism helps to con- trol medical expenses and enhance service quality. In order to better develop the medical insurance negotiation mechanism, after analyzing the theoretical foundation, this article defines the related system framework, sums up international experiences on insurance negotiation mechanism, categorizes the fundamental models applied, and an- alyzes the practical challenges existing in China. The purpose of this article is to explore on path of development for the medical insurance negotiation mechanism in China.