总额预付制中三方利益关系探究

The Tripartite Interest Relationship in Total Prepaid System

目的探讨总额预付制中医、保、患三方的利益关系。方法通过实地考察、政策解读、文献研究等,分析三方利益关系。结果我国实行的总额预付制尚处于初级阶段,在政策制定、实施方法、奖惩机制等方面不统一,需要从医保基金测算、筹资渠道、政策监管、配套措施以及各方支持等方面创造条件。结论总额预付的实施能在一定程度上控制医疗费用,但在医院医保费用合理测算、保护参保人利益和其它配套措施等方面还有待完善。

Objective To investigate the three parties, medical, insurance and patient parties, interests in the total prepaid system. Method Analysis of three party interests was performed by the methods of field investigation, policy analysis, literature research. Result The implementation of China＇s total prepaid system was still at the primary stage. At present, the policy formulation, implementation method, rewards and penalties system were not unified, which needed to be improved from the medical insurance fund estimate, financing channels, regulatory policy, correspondence measures and support of different parties. Conclusion The implementation of the total prepaid system could control medical costs in a certain degree, but it needed to be improved on reasonable estimate of insurance, protection of the insurance participants＇benefits and other supporting measures.