医疗服务供方分担医疗费用风险的探讨

The Research on Medical Expenditures Risk -sharing by Healthcare Suppliers

医疗保险制度有效运作的关键是实施适宜的医疗费用控制策略。本文研究分析管理式医疗的特征及应用效益,探讨将管理式医疗的基本原理引入我国职工医疗保险制度,加强医疗服务供方分担医疗费用增长风险的责任。改革支付方式,强化对供方的制约机制;规范医疗服务提供者的医疗行为;对特定人群疾病的疾病管理(Disease Management)应用;加强医疗保险立法建设;合理控制医疗费用增长,为人民群众提供优质、收费合理的服务。

The key to the success of a medical insurance system is the effecive cost containment mechanism. In this article the feature and merits of managed care were discussed. Then the author explored to apply the main theories of managed care to the reform of our country' s urban employees' medical insurance system in order to strengthen medical suppliers' responsibilities for increasing medical costs. The countermeasures were proposed as ofollows: reforming the methods to pay health services suppliers and strength the control mechanism on suppliers, regulating the behaviors of health services suppliers, applying disease management to specific people, reinforcing construction of medical insurance legislation, ensuring medical expenditures increasing with rational speed and good and affordable health services to be provided to the people.