医疗保险经办机构能力建设的目标和路径

The Target and the Route of the Medical Insurance Agencies' Competency Construction

医疗保险具有分担参保人经济风险和抑制医患道德风险二者相辅相成的双重功能。中国医疗保险较好地履行了第一个功能,亟待强化第二个功能。在中国,医疗保险经办机构是参保人的法定代理人。本文从医疗保障目标、两个路径和四大要素等方面讨论更高层次的医疗保险经办机构能力建设问题。

The main two mutually reinforcing functions of medical insurance are the sharing of the financial burden of the contributors and the prevention of the moral hazards both for doctors and patients. In China, the medical insurance plays the role of the first function very well while the second function needs to be strengthened. The agencies of the medical insurance are the legal proxy of the contributors in China. In this paper, the improvements of the competencies of the medical insurance agencies to a higher level are discussed from the targets of the healthcare security, two pathways and the four main factors.