从价格管制改革到支付制度改革——美国的经验及其对中国医改的启示

发布时间：2018-02-10 10:56

本文关键词： 价格管制支付制度改革医改行政型市场化公共契约模式　出处：《国家行政学院学报》2014年04期 　论文类型：期刊论文

【摘要】：控制医疗费用上涨是各国政府医疗政策的施政重点。最为常见的政府行为是对医疗价格进行管制。20世纪七八十年代,在联邦政府的鼓励下,美国部分州政府出台了医疗费率设定政策,并不断进行调适,但效果不佳。随着医保支付制度改革的推进,价格管制在美国无疾而终了。价格管制以按项目为基础,未能改变医疗服务提供方的激励机制,而支付制度改革则将费用控制转化为供方的内在激励,因此两种改革路径所产生的结果大相径庭。美国医改的经验教训启示我们,医改的根本之道在于放弃行政化的价格管制,改为大力推进医保支付制度改革,在医保机构和医疗机构之间建立公共契约模式,让以预付制为主的新市场机制在医疗资源的配置上发挥决定性作用。
[Abstract]:Controlling the rise in health care costs is the focus of government policy. The most common government action is to regulate health care prices in the 1970s and 1980s, encouraged by the federal government. Some states in the United States have introduced policies to set medical rates and adjusted them constantly, but the results have not been good. With the reform of the health care payment system, price controls have come to an end in the United States. Price controls are on a project-based basis. The failure to change the incentive mechanism of medical service providers and the reform of the payment system translate the cost control into the intrinsic incentives of the supply side, so the results of the two reform paths are quite different. The fundamental way of medical reform is to abandon the administrative price control, and instead vigorously promote the reform of the medical insurance payment system, and establish a public contract model between the medical insurance institutions and the medical institutions. Let the new market mechanism based on prepaid system play a decisive role in the allocation of medical resources.
【作者单位】：北京大学;重庆行政学院;
【分类号】：R199;D971.2

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