医疗保险谈判机制构建的现状分析及路径探索

A Situation Analysis and Pathway Exploration on Mechanism Construction of Medical Insurance Negotiation

建立社会医疗保险谈判机制是我国医疗卫生体制改革深入发展的迫切需要,也是实现医疗保障政策有效性的重要保证。由于医疗保险覆盖面窄,医疗保险经办机构的能力及动力的局限,导致我国医疗保障政策制定中谈判机制的缺失。而社会医疗保险谈判机制缺失正是我国社会医疗保险制度改革中出现的一些政策失误和面临困境的重要原因之一。为使社会医疗保险制度改革顺利发展,应该通过实施科学的制度保证、政府信息公开、谈判主体的角色定位、谈判代表的产生、谈判内容确定、谈判结果公布等制度建设,以及加强监督管理等措施,建立起完善社会医疗保险谈判机制。

To set up the negotiation mechanism of social medical insurance is extremely urgent for the development of the reform of medical care system in China,and is also the important guarantee to accomplish the efficiency of social medical insurance.It leads to the absence of negotiation mechanism of social medical insurance because of its limited coverage,and the limitations of capability and motivation in the medical insurance agencies.It is the absence of negotiation mechanism of social medical insurance that results in policy faults of social medical insurance reform.To develop the social medical insurance reform smoothly,it is necessary to set up the whole systems of negotiation mechanism of social medical insurance by carrying out the construction of scientific system guarantee,the open of government information,role orientation of main negotiation agencies,election of the delegate to the negotiations,negotiation content,announcement of negotiation result,and also by strengthening regulation management.