关于按服务项目支付的探讨

按服务项目支付是中国医疗保险实践广泛采用的结算方式。文章分析了在医疗保险中医院、患者、医疗保险经办机构各自的目标、行为以及在不同的报销模式下的行为选择，并进一步得出，医疗保险经办机构采用不同的报销模式将导致不同的主体间关系、不同的医疗保险满意度以及医疗资源利用水平。中国医疗保险事业缺乏西方国家成熟的商业保险行业组织以及相应的经验和信息积累。变更医院的目标函数和约束条件是更加合理地利用医疗资源的关键。

Pay on Fee in China

Pay on fee is a widely used way of settlement in the medical security system of China.This paper analyzes the objectives and action choices under different reimbursement patterns taken by hospitals,patients and medical security organizations.Further analysis shows that different reimbursement patterns taken by the medical security organizations will lead to different interrelationships,different satisfied degrees and utilization levels of medical resources.Lack of business insurance organizations and management experience and information accumulation,the settlement way of pay on fee in China has to be used for a long time.The key to utilize medical resources more properly is to modify object functions and constraint conditions of hospitals.