我国公共医疗卫生服务定价机理与价值补偿研究——基于供需双方价值补偿的视角

Research on Pricing Mechanism of Public Health and Medical Service and Value Compensation——from the Perspective of Value Compensation for Suppliers and Demanders

我国公共医疗卫生服务供给遵循市场价格机制与契约治理规则,整个供给流程存在产权委托代理链和价值补偿链。资金流包括卫生费用筹集和医疗服务消费价值补偿两个方向,需方医疗卫生总费用由政府公利、社会共济和个人付费的多元分摊机制承担;医疗机构等供方通过财政补助和医疗服务事业收入获得成本补偿和合理收益。在医疗保险等第三方偿付机构的介入下,多方利益主体之间的博弈带来"公域"部门道德风险和"私域"部门市场失灵问题,其激励源于行政分权和财政分权改革。规范各参与主体的效用目标,加强监管,整合城乡医疗保障制度,对提高医疗服务利用率、增进社会公平有积极意义。

China＇s supply of medical and health service follows a market-pricing mechanism and a formula of contract-based governance.The supply process includes two chains of principal-agency of property right and value compensation.Capital flow runs in the two directions of heath expenditure collection and value compensation for medical service consumption.The general expenditure on health and medical service on the demanders＇ side is to be shouldered by a multiple mechanism composed of governmental interest,social relief and individual payment.The suppliers,such as medical institutions,obtain cost reimbursement and reasonable earnings through financial aid and health and medical service.With the intervention of the third parties such as medical insurance,the interaction among interested parties leads to the problems of moral hazard in public sector and market failure in private sector,the incentive to which is the reform of division of administrative power and public finance.The regulation of efficiency goals for corresponding participants,strengthening supervision and integration of medical security systems in both urban and rural areas,all play positive roles in improving the accessibility of medical service and enhancement of social justice.