罗湖医保支付方式改革模式与HMO医疗服务模式比较研究

The comparative study of the reform of Luohu medical insurance payment mode and the HMO mode

伴随美国医保发展的全历程,健康维护组织曾被认为是控费模式的典范,其控费理念和机制是专家学者的研究焦点。部分学者和媒体将罗湖医保支付方式改革模式视为"健康维护组织探索先行者"。从控费机制、医保支付方式、居民就医选择权、风险选择和服务内容等方面对2种模式进行对比研究,为同行业借鉴健康维护组织医疗服务模式提供参考意见。

With the development of the American health care and insurance. HMO was considered as the mode of controlling costs in nearly a century. The control costs philosophy and mechanism have been the focus of the experts and scholars. Recently, some scholars and the media will reform of Luohu medical insurance payment mode as ＂HMO exploration pioneer＂, This article compared the two modes in aspects of cost control mechanism, medical insurance payment mode, residents＇ medical treatment option, risk selection and service content to provide reference on applying HMO mode.