治理视域下医疗服务价格谈判机制研究

Study on Medical Care Service Price Negotiation Mechanism in the View of Governance

完善全民基本医保制度是推进健康中国战略的重要内容。医改进入深水区,利益格局深度调整不可避免,体制机制的矛盾更加突出。新医改以来,多项政策文件均提出要探索建立"医疗保险经办机构与医疗机构、药品供应商的谈判机制",以发挥"医疗保障对医疗服务和药品费用的制约作用,形成激励与约束并重的支付制度"。本文采用定性研究的方法,运用治理理论探讨医疗服务价格谈判机制,主张在多方参与、伙伴关系、协同共治、协调各方利益的原则下,各方主体在多元协商的框架下将矛盾冲突显性化,互动博弈透明化,利益诉求谈判化,共同决策契约化,完成上述目标,实现"医、患、保"三方共赢。

Perfection on the universal Basic strategy. Health care reform entering a critical interests is inevitable and the institutional Medical Insurance system is part of Health China stage and a deep water zone, a depth adjustment of contradiction is more outstanding. Since the New Health Care Reform, a set of policies put forward to ＂build a negotiation mechanism among medical insurance agency, medical institutions and drug supplier＇~nd ＇~lay the constraint function of medi- cal security on costs of medical services and drugs and form the incentive and constraint payment system. This paper adopts the method of qualitative research, applying the governance theory to study the medical care service price negotiation mechanism. It argues a set of principles including participating of multiple parties, partnership, collaborative work, and coordinating the interests of all parties. It proposes that complete the above goals by explicit conflicts, transparent interac- tive game, interests negotiations, joint decision-making leasing under a framework of consultation and achieve a tripartite win-win situation among physician, patient and insurance.