借鉴美国经验探索构建我国面向健康管理的医疗保险制度

Referring to American experience to explore the establishment of the medical insurance system for health management in China

随着我国国民经济的发展,慢性病的疾病负担不断加重,医疗费用也随之上涨。根据国外的实践经验,实行以预防为主的健康管理是控制医疗费用急剧上涨的有效策略。借鉴美国从传统的按项目付费到有效的管理式医疗再到新兴的基于价值的补偿机制的发展历程,我国需要转变现存的医疗保险支付方式来推动我国健康管理事业的发展。从美国的支付方式改革实践可知,以健康改善状况为评价标准的按价值付费的支付方式更适合健康与医疗的长远发展,我国应从政府、商业保险机构和医疗机构三方共同探索面向健康管理的医疗保险制度。

With the development of national economy, the disease burden of chronic diseases is increasing and the medical expenses are rising. According to the practice of foreign medical expense controlling, to implement health management is an effective strategy to control the sharp rise of medical expenses. Referring to the development of the payment mode in American from the traditional fee-for-service to the efficient manage care and from the manage care to the burgeoning value-based reimbursement, China needs to change the existing medical insurance system to promote the development of health management. According to the practice of the payment reform of the American medical insurance, the value-based reimbursement which is based on the health improvement is more suitable for the long-term development of the health and medical career. China should jointly explore the health insurance system for health management from the government, commercial insurance agencies and medical institutions.