美国管理型医疗模式对中国健康维护组织发展的启示

The Enlightenment of American Managed Care on the Development of Health Maintenance Organization in China

目前许多企业借鉴美国管理型医疗模式探索健康维护组织在我国的本土化发展。介绍了美国健康维护组织的内涵、发展及四种模式,并对四种模式进行比较;从预付制、严格的分级诊疗及转诊制度、注重健康管理、高效信息共享平台和完善的评估监督机制五个角度阐述美国健康维护组织的特点;指出当前健康维护组织在中国的发展现状及不足,提出转变政府职能、改革支付方式、聚焦基层,通过重视商业医疗保险和基层卫生服务的融合大范围推行健康维护组织本土化的三方面建议,以期推动中国健康维护组织的发展。

The indigenization of Health Maintenance Organization(HMO)is explored by enterprises in China with the reference to managed care in the United States.This paper introduces the connotation,development and four patterns of HMO in the United States.Describing its characteristics in terms of prepaid system,tiered health care system,health management,information sharing system and supervision system.It points out the development and existing issues of the HMO in China.Some suggestions such as transforming government functions,reforming payment method and focusing on the primary level to implement HMO on a large scale are proposed to promote the indigenization of HMO in China.