政府和商业保险公司经办新农合的运行机制比较

Comparison of the Operating Mechanism of the New Rural Cooperative of Government and Commercial Insurance Companies

商业保险公司经营新农合业务是卫生改革中的新现象,存在一定的矛盾与困惑。通过对政府和商业保险公司经办新农合模式的运行机制即结算流程、投诉反应性、对医疗机构的监管和基金流向的管理方面的比较,归纳出政府和保险公司运行的不同模式及之间的差异。商业保险公司参与新农合经办,微观上提高新农合服务质量和对医疗机构的监管,但也增加了新农合运行的社会成本;从理论和机制上看,商业保险公司参与新农合并非必需。

Commercial insurance companies operating the new rural cooperative business is a new phenomenon in the health reform,and there is a certain contradiction and confusion.Comparison of settlement process,response to complaints,medical institutions supervision and management of fund flows of the new rural cooperative mode between the government and commercial insurance companies,and the different modes between the government and insurance companies are summed up.Commercial insurance companies participating in the new rural cooperative management can improve service quality of the new rural cooperative medical and supervision of medical institutions in the micro,but it also increases the social costs of the new rural cooperative run;from the point of view of the theory and mechanisms,commercial insurance companies participating in NRCMS is optional.