医疗保险定额付费方式有效性的探讨

The efficiency of fixed price payment in medical insurance

医疗保险中的定额付费方式指不论实际发生了多少医疗费用,均以事先确定的标准向医疗机构支付费用,这种支付方式的有效运作意味着可以在控制医疗费用的同时又确保医疗质量。本文认为可能对定额付费方式有效性产生影响的因素包括服务质量对患者诊疗需求的影响程度;医疗机构增加患者诊疗需求的意愿;医疗机构的拒诊和撇脂行为;经办机构在合同签订方面的权限。

Fixed Price Payment （FPP） refers to one of the insurance programs that pay out a prefixed amount to the medical service provider irrespective of the actual costs of the treatment. The efficient operation of the FPP pro- gram will help to keep healthcare costs down and also ensure the quality of medical services at the same time. The factors which will affect the efficiency of FPP program are：the impacts of the quality of medical services on the patients＇ demand for the services; the hospital＇s willingness to increase the demand for medical services and their cream-skimming and refusal behaviors;and from the insurance agents＇ point of view, the authorization of the medical insurance contracts.