国内外医疗保险评估指标体系研究综述

Review of the Assessment Index System of Health Insurance Local and Overseas

医疗保险评估指标体系的构建是评估工作的重要环节。本文首先对国外的医疗保险评估理论进行简单的介绍,并结合英国、美国和巴西三国的医疗保险评估指标体系研究,发现国外的医疗保险评估指标体系主要分为两类,一类是偏向于评估医疗保险的效率,一类是偏向于评估医疗保险的公平,但实际操作中都是效率和公平的结合,只是侧重点不同。然后,对国内医疗保险评估指标体系的相关研究进行分析,主要包括对城镇职工基本医疗保险、新农合和城镇居民医疗保险的评估。最后,对比国内外的医疗保险评估可以发现国外的评估对象一般是整个医疗保险制度,而我国现有的研究多是对某一项医疗保险制度的评估;随着一体化的医疗保障体系的逐步迈进,需要加强对全国基本医疗保险评估的研究。不同的医疗保险制度类型会影响评估的侧重点,全民医保模式的更加关注公平,市场主导型的更加关注效率。评估主体会影响评估指标体系的建立,不同的评估主体也会出现不同的评估指标体系。

To construct assessment index system of medical insurance is an important part of the assessment work. Firstly, the paper briefly introduce the abroad theory of the medical insurance assessment, combined with research evaluation system of medical insurance in UK, US and Brazil three countries, and find that health insurance assessment system overseas can be divided into two categories, one is inclined to assess Medicare efficiency, one is inclined to assess the health insurance fair, but the actual operation are binding efficiency and fairness. Then, the paper analyses the relevant national health insurance research evaluation system, including an assessment of basic medical insurance for urban employees, urban residents and the new rural cooperative medical insurance. Finally, comparing the assessment in home and abroad, we can find foreign assessment objects are generally the entire medical insurance system, and much of the existing research is the evaluation of a particular medical insurance system in our country;with the gradual integration of the health care system ,we need to strengthen the national basic medical insurance assessment study. Different types of medical insurance system will affect assessments, focus more attention equitable universal health care model, market - oriented pay more attention to efficiency. The different assessment body will affect the establishment of evaluation index systems, and will be a different evaluation system.