医疗保险谈判机制浅析

Analyzing the medical insurances negotiation system.

医疗保险谈判机制作为医疗保险制度的重要组成部分,是医疗服务购买方与提供方通过谈判,就服务范围、价格、标准以及付费方式等内容达成协议,明确双方的责、权、利的一种制度安排。文章对医疗保险谈判机制的产生背景、内涵和总体目标、基本框架以及医疗保险经办机构谈判的优势进行了浅析,并对今后医疗保险谈判机制的建立提出了几点思考,以期对我国医疗保险谈判机制的发展有所贡献。

Objective：As an important part of medical insurance system, medical insurance negotiation mechanism is a process to achieve agreement by negotiation between medical services consumer and provider, on the scope, price, standard of medical service, the way to pay, and bilateral responsibilities, rights and benefits. The background, connotation ,framework and overall goal of medical insurance negotiation mechanism were analyzed. And the advantages of medical insurance office were also studied. Based on which, some countermeasures were put forward to contribute to develop Chinese medical insurances negotiation system.