发展商业医疗保险的纵向一体化研究——兼论代理成本与交易成本的规制选择

On the Vertical Integration of Commercial Medical Insurance Development

对医疗费用的增长以及医疗保险与医疗服务之间交易成本的控制 ,对医疗保险尤其是商业医疗保险的经营与发展至关重要。以代理成本最小化为契约基础的委托代理方式 ,并无法将跨时期的、不确定的、剩余收益、权利的对比等交易费用因素纳入均衡契约约束的框架 ,代理成本的制约机制———代理目标最优激励契约 ,亦不能有效控制知识经济背景下医疗技术、知识、信息资本的相对垄断对医疗保险与医疗服务所产生的交易成本和医疗费用的增长。基于交易成本经济学理论的纵向一体化策略 ,医疗保险与医疗服务的合并 ,可以对交易成本和医疗费用形成有效的制约机制。

It is important for the development of the medical insurance especially for commercial medical insurance to control the increase in medical expenses and transition cost between medical insurance and medical services. The mode of principal-agent based on minimized agent cost can not make into equilibrium contract framework the factors of transition cost such as transtemporal uncertainty, residual claims and rights balance. Optimal incentive contract as the restricted mechanism of agent cost can not effectively control increase in agent cost and medical expenses either, which are relatively brought by monopolizing medical technology, knowledge and information capital under knowledge economy. The vertical integration strategy based on the theory of bargaining cost, namely the combination of medical insurance and medical services, can effectively restrict bargaining cost and medical expense.