国外医疗体制机制与医保付费方式的适配理论

Studying on the adaptation theory of medical service system and medical insurance payment methods abroad

医疗服务体制机制和医疗保险付费方式的制度适配是医疗卫生体系充分发挥功能的根本前提。文章从国外行政学、管理学、经济学中提炼出医疗服务体制机制与医疗保险付费方式的五大适配理论:政府购买服务理论、有管理的竞争理论、花钱矩阵理论、责权利均衡理论、激励相容理论,为我国公立医院体制机制与医疗保险付费方式的协同改革提供理论参考。

The adaptation of medical service system and medical insurance payment method is the prerequisite for the health- care system＇s function. Five adaptation theories of medical service system and medical insurance payment methods were extracted from complicated administrative science, management science and economics in foreign countries, which were government-purcha- sing services theory, managed competition theory, spending-money matrix theory, responsibility-power-interest equilibrium theory and incentive compatibility theory, to provide theoretical references for coordinated reform on public hospitals＇ system mechanism and medical insurance payment method in China.