从美国医师、医院、医保机构的制约关系探讨我国医药费用控制
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篇名: 从美国医师、医院、医保机构的制约关系探讨我国医药费用控制
TITLE:
摘要: 目的:为我国医药费用的控制提供参考。方法:运用信息不对称与委托代理、弗里德曼的消费理论,结合美国医疗卫生服务体系的主要特点,分析美国医师、医院、医保机构三者之间均衡的制约关系在控制医药费用和提高诊疗质量方面的优势;同时比较我国与美国在医药费用增长率、药占比等方面的差异,论证上述制约关系对医药费用控制的作用。结果与结论:美国的医疗服务实行分级诊疗与双向转诊制度、盈利性医院与非盈利性医院相互补充、不同性质的医保体系并存、实行不同的付费方式、实行严格的商业贿赂监管制度,其医师、医院、医保机构三者之间形成的是一种相互制约的均衡关系。其不仅在理论上存在诸多优势,在实际控制费用增长率、药占比等方面也优于我国,在一定程度上控制了医疗费用的快速增长。结合我国国情,有必要借鉴美国的经验,从降低信息不对称与规范支付审核、建立科学的混合型支付方式、加强医保机构对医师和医院的间接影响等方面,构建我国医师、医院、医保机构三者之间的均衡制约关系,从而有效控制我国医药费用的增长。
ABSTRACT: OBJECTIVE: To provide reference for medical costs control in China. METHODS: Based on main characteristics of the United States health service system, information asymmetry, principal-agent theory and Freedman’s consumption theory were used to analyze the advantages of restrictive relationship among doctors, hospitals and health insurance institutions in controlling medical costs and improving the quality of diagnosis and treatment. The growth rate of medical cost, the percentage of drug expenditure and other aspects were compared between China and the United States; the effect of restrictive relationship on medical cost control was demonstrated. RESULTS & CONCLUSIONS: In the United States, there are hierarchical medical system and two-way referral system; for-profit hospitals and non-profit hospitals are mutually complementary; different natures of health insurance system, different payment methods and strict “commercial bribe” monitoring system are carried out; doctors, hospitals and health insurance restrict each other. Not only there are many advantages in theory, but also in practice the growth rate of medical cost and the percentage of drug expenditure are superior to our country. Finally it controls the rapid growth of medical cost to a certain extent. Combined with our national conditions, learning from the United States experience, restrictive relationship among doctors, hospitals and health insurance institutions is established to control the increase of medical cost in China through reducing information asymmetry and standardizing payment audit; establishing a scientific pattern of mixed payment; strengthening the indirect impact of the health insurance institutions on doctors and hospitals, etc.
期刊: 2016年第27卷第16期
作者: 宗毛毛,尤晓敏,赵瑞,袁丽,杨悦
AUTHORS: ZONG Maomao,YOU Xiaomin,ZHAO Rui,YUAN Li,YANG Yue
关键字: 医师;医院;医保机构;制约关系;医药费用;美国
KEYWORDS: Doctor; Hospital; Health insurance institution; Restrictive relationship; Medical cost; United States
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