公立医院管制型市场化体制与医疗保险付费方式的错配分析

Mismatching analysis of public hospital administration-based market system and medical insurance payment

公立医院体制机制与医疗保险付费方式的协同改革取决于两者的制度适配。管制型市场化体制是国内公立医院体制机制的主要形态,后付费方式与预付费方式并存是国内医疗保险付费方式的主要形态。作者以功能匹配为视角,分析了公立医院管制型市场化体制与医疗保险两种付费方式的双向错配,然后提出公立医院体制机制与医疗保险付费方式适配的路径选择,即将公立医院的管制型市场化体制改革为治理型市场化机制,以构建公立医院治理型市场化机制与医疗保险预付费方式的制度组合。

Cooperative reform of public hospitals system and the medical insurance payment depend on system adaptation of both. The administration-based marketization system is the main form of public hospitals system in our country. Coexist of post-payment and pre-payment is the main form of the medical insurance payment in China. The author analyzed the bidirectional mismatch of public hospital administrationbased marketization system and medical insurance both payment, then further proposed the path of public hospital system and medical insurance payment match from the perspective of function matching: administration-based marketization system will be reformed to governance-based marketization mechanism, in order to form a combination system of public hospitals governance-based marketization mechanism and medical insurance prepaid.