医疗服务机构在医疗保险逆选择中的角色扮演

医疗保险中存在的逆选择问题阻碍了我国医疗保险事业发展。从医疗保险逆选择过程的第三方即医疗服务机构角度出发探究如何解决逆选择困境,结合预期效用理论对医疗服务机构在逆选择过程的角色扮演作出阐述,指出医疗服务机构行为构成逆选择的重要制约因素,认为实施群组保险等解决逆选择困境的措施必须与医疗服务机构改革相结合才能取得成效。     

公平视角下的全国儿童大病医疗保障制度研究

医疗卫生服务公平包括服务的可及性、可获得和利用公平.我国城乡和地区间经济社会发展差距较大,短期内很难解决全国儿童医疗卫生服务利用的公平性问题.儿童大病与不同经济水平下的生存条件、医疗服务水平有关.作为未来社会的竞争主体,他们不应在患大病时因经济原因而生存公平受到威胁.无论是从公共管理理论,还是从儿童大病保障的成本效益角度看,应由卫生部负责建立全国统一的儿童大病保障方案,在条件成熟时逐渐过渡到全国儿童大痛医疗保险体制,实现儿童大病的公平保障.     

为医保定点医疗机构和药店管理出招

从1998起,随着城镇职工基本医疗保险制度的改革,全国各地逐步形成了以个人账户和社会统筹相结合的职工基本医疗保险以及城镇居民基本医疗保险互为补充的新型医疗保险机制。取代了长期以来机关事业单位公费医疗和企业劳保医疗制度,带动和促进了各地医疗卫生体制改革和药品生产流通体制的改革,医疗保险制度改革成果逐步显现。但随着改革的不断深入,医疗保险又遇到了提高社会保障能力摄影     

关于新医疗制度改革的研究综述

在经济发展的基础上,保证人民群众公平享有公共卫生和基本医疗服务,是实现人民共享改革发展成果的重要体现。中国医药卫生体制经过多次改革和发展,取得了很多成就,但也存在一些问题,尤其是国家的经济发展进入新阶段,原有医疗体制有很多制度与经济发展阶段不符。公民的医疗卫生保障需求日益增加,如何在新形势下解决公民的医疗问题,2009年的新医改方案就是一次重要的制度再设计。     

筑牢医保基金防护安全网

随着医疗保险事业的不断发展,保障范围逐步扩大,便捷高效的管理模式方便了医保患者就医,同时也为一些违规医院和个人提供了可乘之机,医院违规操作、患者冒名刷卡、医患串通骗保等严重扰乱了医疗卫生和医保运行秩序。为确保医保基金安全,维护参保人员的利益,天津社保北辰分中心不断深化职能,加大对医疗行为的指导监控职责,逐步形成了对定点医疗服务机构、医保服务医师和患者的监督管理机制,为医保基金安全筑起了一道安全网。     

日本医疗保险制度经验对中国的启示

日本是一个与中国有许多相同历史文化传统的国家,因此,参考日本医疗保险制度实施状况对完善中国的医疗保险制度具有重要的借鉴意义。日本从1961年起实行“全民皆保”的医疗保险,较好地解决了国民的医疗需求问题,其医疗保险管理体制、应对人口老龄化及资金等问题进行的改革对中国医疗保险的改革具有重要的借鉴意义。本文在分析日本医疗保险制度成功经验及特点基础上,提出当前中国医疗卫生体制改革推进之时,借鉴其经验,高度重视建立覆盖全民的基本医疗保险制度,加大政府对医疗服务领域的资金投入,合理分配医疗卫生服务资源,完善中国医疗保险制度等对策。     

三医联动改革对策研究

医疗卫生体制改革是一个涉及多方利益的综合性改革,其中医疗、医药和医保是医疗卫生系统中尤为重要的三个子系统,只有加强医保、医药、医疗三者之间的联动改革才能真正发挥医药卫生作用,最终实现"人人享有基本医疗卫生服务"的目标。     

我国医疗保障事业发展的历程和经验

我国医疗保障事业建立、改革、发展经过了计划经济体制下的单位保障、市场化改革背景下的医疗保险、全面建设小康社会目标中的全民医疗保障。发展我国的医疗保障事业必须以科学发展观为指导,将保障人民健康作为根本宗旨;医疗保障事业建设必须立足国情,与经济发展水平相适应;各项医疗保障必须要协调发展,积极推进医疗保障制度一体化;医疗保障与医药卫生服务体系建设必须要全面推进,深化医药卫生体制改革。     

我国医疗保障事业发展的历程和经验

我国医疗保障事业建立、改革、发展经过了计划经济体制下的单位保障、市场化改革背景下的医疗保险、全面建设小康社会目标中的全民医疗保障。发展我国的医疗保障事业必须以科学发展观为指导,将保障人民健康作为根本宗旨;医疗保障事业建设必须立足国情,与经济发展水平相适应;各项医疗保障必须要协调发展,积极推进医疗保障制度一体化;医疗保障与医药卫生服务体系建设必须要全面推进,深化医药卫生体制改革。     

医患关系紧张问题究竟出在哪儿?

我国开始的医疗卫生事业改革,从宏观上看是市场机制的引入,而微观上是让公立医院自负盈亏,自我发展。这种医疗职能的社会定位和政策导向,在某种程度上使医疗卫生事业偏离了"救死扶伤"公益属性的轨道,尤其是在医     

对我国与公共卫生事业相分离的医疗保险制度的反思

我国目前建立的狭义的“医疗保险”面临诸多困境“,看病难、看病贵”成为一种社会问题。然而从现实出发,我国处于社会主义初级阶段的国情决定了我们必须探索一条投入产出比高的医疗保险模式实现保障人民身体健康的目标。对于目前已有的制度而言,公共卫生事业是否应与医疗保险制度相结合,是值得反思的问题。     

政策性破产企业退休人员医疗保险问题探讨

随着国有企业政策性破产的实施与医疗保险制度改革的发展,政策性破产企业退休人员的医疗保险成为社会各界普遍关注的热点和焦点问题。本文主要探讨了政策性破产企业退休人员医疗保险存在的问题及其对策。     

The health care system of the People's Republic of China: Between privatization and public health care

Chinese health care policy has undergone numerous reforms in recent years that have often led to new challenges, inciting the need for further reform. The most recent reforms attempt to find a middle path between public health care provision and commercial private insurance. In this way, China is following in the footsteps of countries that initially increased the role of privatization in the 1990s and at the beginning of the 21st century, but are now gearing towards public health care. However, this process of constant reform has led to a lack of transparency in the functioning of the health care system, provoking a loss in public trust. There remains an important degree of uncertainty about the future direction of developments in China. Nonetheless, a dual financing approach to health care using tax finance and social insurance might yet crystallize, offering a potential model to inform developments in other countries.     

Healthcare financing reform and the new single payer system in the Republic of Korea: Social solidarity or efficiency?

In July 2000, national health insurance in the Republic of Korea was transformed into a single insurer system. This major reform in healthcare financing resulted from the merger of more than 350 health insurance societies. Inequity in healthcare financing and the chronic financial situation of the health insurance societies for self–employed workers in rural areas have been the driving forces leading to the unified health insurance system. The unique institutional context together with political change opened the window of policy change, and various stakeholders such as politicians, rural self–employed workers, trade unions and civic groups were involved in the healthcare reform process. Fair income assessment of the self–employed and the role of the single insurer as a prudent purchaser of medical care will be vital for the new system to achieve its intended goal and improve social solidarity and efficiency of healthcare.     

Social health insurance development in Mongolia: Opportunities and challenges in moving towards Universal Health Coverage

Mongolia achieved high population coverage under mandatory health insurance relatively quickly. This fact was viewed by policy‐ and decision‐makers as a central issue for health financing reform in Mongolia. Health insurance brought many new features for health service planning, provision, funding and resource management. Based on initial achievements, health insurance came to be strategically considered as the vehicle for achieving universal coverage. The article analyses developments in Mongolia's health insurance over the last decade along with the core policy dimensions of Universal Health Coverage. It examines various reform approaches and the numerous amendments to laws that have been implemented during this period and discusses new opportunities as well as challenges. The analytical review and findings discussed suggest that Mongolia has a need for evidence‐based policy decisions and informed political support, with health insurance backed by robust institutional and administrative capacities. More generally, it also emphasizes that health policy goals and objectives can be attained by strengthening and making transparent and publicly‐accountable all health system financing functions and arrangements. The policy analysis, experiences, lessons and proposed strategies presented with regard to Mongolia intend to stimulate wider discussions on health insurance development as well as promote continuing focused research on specific aspects of health insurance and public financing reform.     

The Fiscal Crisis of National Health Insurance in the Republic of Korea: In Search of a New Paradigm

In 2001, National Health Insurance (NHI) in Korea, the social insurance system for health care with universal population coverage, experienced a serious fiscal crisis as its accumulated surplus was depleted. This fiscal crisis is attributed to its chronic imbalance: health care expenditure has increased more rapidly than have insurance contributions. The recent failure in implementing pharmaceutical reform was a further blow to the deteriorating fiscal status of the NHI. Although the NHI has since recovered from the immediate fiscal crisis, this has mainly been because of a temporary increase in government subsidy into the NHI. The strong influence of the medical profession in health policy‐making remains a major barrier to the introduction of policy changes, such as a reform of the payment system to strengthen the fiscal foundations of the NHI. Korea also has to restructure its national health insurance in an era of very rapid population ageing. A new paradigm is called for in the governance of the NHI: to empower groups of consumers and payers in the policy and major decision‐making process of the NHI. The fiscal crisis in Korean national health insurance sheds light on the vulnerability of the social health insurance system to financial instability, the crucial role of provider payment schemes in health cost containment, the importance of governance in health policy, and the unintended burdens of health care reform on health care financing systems.     

农村商业健康保险的定位及发展模式

商业健康保险是农村医疗保障体系的有机组成部分。它在满足农村居民个性化的风险保障需求以及提供专业化的经办管理服务方面能发挥积极作用。在农村医疗保障体系中,公共医疗保险居基础性地位,商业健康保险则居补充性地位,两者应协调发展,共同构建我国农村多层次医疗保障体系。现阶段,我国农村商业健康保险发展模式包括补充型发展模式、替代型发展模式以及第三方管理模式三种类型,其未来发展模式包括医保合作模式、第三方管理模式,以及最终打造成以健康保障为中心、集医疗服务提供与经办管理服务为一体的农村商业健康保险产业链发展模式。