医疗保障制度中第三方医疗费用控制研究

Third-party Medical Expenditure Control in the Medical Insurance System

建立公立医疗保险制度是我国医疗保障制度改革的核心内容,医疗市场形成三方利益格局。随着医保覆盖面的进一步扩大,控制医疗费用的快速上涨已经成为医保经办机构治理变革的重要内容。本文基于医疗费用快速增长的大背景,从第三方医疗费用控制的重要性和必要性方面进行分析,提出扩大医保覆盖率、创新费用支付方式、加强管理和监督、构建医保机构之间的竞争机制等对策建议。

Developing the public medical insurance system is the core of Chinese medical security reform.There are three interest groups parties turning up in the medical market.With the coverage expansion of the system,controlling health expenditure is important and necessary.This paper discusses the importance and necessity of third-party medical expenditure control,and puts forward suggestions to improve the medical insurance system by expanding the coverage,innovating the payment,improving supervision and administration,and introducing competition among medical insurance agencies.