摘要
新医改促生了一个"双增"悖论:医保快速发展的同时,医疗费用和个人负担也在快速增长。前人研究关注"技术决定论",即医保付费方式改革对费用增长的抑制作用;但鲜有研究关注医保经办机构组织能力对医疗费用的影响。论文采用混合研究方法,检验医保经办机构的激励机制、资源约束和监管成本与医疗费用增长之间的关系。定性研究基于三个城市的田野调查,发现医保经办机构控费能力孱弱的原因在于激励不足、资源匮乏和监管成本过高。定量研究采用省际面板数据,发现医保经办机构激励不足和行政经费有限导致医疗费用增长。指出,要从根本上抑制医疗费用过快增长,必须加强医保经办机构的能力建设、控费激励和资源投入,完善第三方购买机制。
The newest round of health care reform in China has produced a paradox:while social health insurance coverage has expanded rapidly,healthcare costs and out-of-pocket expenditureshave increasedquickly too. Previous studies focused on the role payment methods played in curbing medical costs,but few investigated the impact of the organizational capabilities of the relevant social health insurance agencies. Employing a mixed-methods design,this study examines the effects of incentive structure,resource constraints,and regulation costs for these insurance agencies as they relate to medical cost inflation. Based on fieldwork in three Chinese cities,the study's qualitative results attribute the weak role insurance agencies play in cost containment to lack of incentives,insufficient resource input,and high regulation costs. Using panel data analysis,the study's quantitative findingsshow a lack of incentives and insufficient financial resources lead to medical cost inflation. This paper suggests the government could improve the organizational capabilities of social health insurance agencies and third-party purchasing by reforming their incentive structures and investing financial resources.
出处
《公共行政评论》
CSSCI
北大核心
2018年第2期114-136,192,共23页
Journal of Public Administration
基金
国家社会科学基金青年项目"医疗费用增长与社会医疗保险可持续性研究"(16CSH032)
关键词
医保经办机构
组织能力
医疗费用增长
Social Health Insurance Agency
Organizational Capability
Medical Cost Inflation