医保协商谈判和协议管理的政策机制研究

Research on the Policy Mechanism for Medical Insurance Negotiation and Agreement Management

医疗保险协商谈判与协议管理是新时期医保制度完善的关键环节与政策抓手,有利于医保主管部门对医疗服务和药品质量进行有效监管。本研究认为应坚持问题导向,梳理各地在医保协商谈判过程中需要解决的主要问题。在此基础上明确工作路径,进一步完善多元主体参与协商谈判与协议管理的政策保障机制,构建多元主体参与协商谈判的信息共享平台与平等对话机制,加强医保协议管理的严格执行与服务质量的动态监管。

The negotiation and agreement management in medical insurance is the key and policy starting point to improve the health care system in the new era, and they are benefi cial for the medical insurance administrative departments to monitor medical services and the quality of medicines effectively. This research suggests that problem-orientation should be insisted on and the main problems in the health insurance negotiation process are clarifi ed. Based on this, it should make clear the working path, further improve the policy supportive mechanism with multiple subjects involved in negotiation and agreement management, build information sharing platform and equal dialogue mechanism, and strengthen the strict implementation of medical insurance negotiation management and services dynamical supervision.