国内外医疗保险评估指标体系研究综述
发布时间：2018-11-26 18:25
【摘要】：医疗保险评估指标体系的构建是评估工作的重要环节。本文首先对国外的医疗保险评估理论进行简单的介绍,并结合英国、美国和巴西三国的医疗保险评估指标体系研究,发现国外的医疗保险评估指标体系主要分为两类,一类是偏向于评估医疗保险的效率,一类是偏向于评估医疗保险的公平,但实际操作中都是效率和公平的结合,只是侧重点不同。然后,对国内医疗保险评估指标体系的相关研究进行分析,主要包括对城镇职工基本医疗保险、新农合和城镇居民医疗保险的评估。最后,对比国内外的医疗保险评估可以发现国外的评估对象一般是整个医疗保险制度,而我国现有的研究多是对某一项医疗保险制度的评估;随着一体化的医疗保障体系的逐步迈进,需要加强对全国基本医疗保险评估的研究。不同的医疗保险制度类型会影响评估的侧重点,全民医保模式的更加关注公平,市场主导型的更加关注效率。评估主体会影响评估指标体系的建立,不同的评估主体也会出现不同的评估指标体系。
[Abstract]:The construction of medical insurance evaluation index system is an important link in the evaluation work. This paper first introduces the medical insurance evaluation theory in foreign countries, and studies the evaluation index system of medical insurance in the United Kingdom, the United States and Brazil, and finds that there are two main categories of the evaluation index system of medical insurance in foreign countries. One is to evaluate the efficiency of medical insurance, the other is to evaluate the fairness of medical insurance, but in practice there is a combination of efficiency and fairness, but the emphasis is different. Then, the related research on the evaluation index system of the domestic medical insurance is analyzed, including the evaluation of the basic medical insurance for urban workers, the new rural cooperative medical insurance and the urban residents' medical insurance. Finally, by comparing the domestic and foreign medical insurance evaluation, we can find that the object of assessment abroad is generally the whole medical insurance system, but most of the existing research in our country is the evaluation of a certain medical insurance system. With the development of the integrated medical insurance system, it is necessary to strengthen the research on the national basic medical insurance evaluation. Different types of medical insurance system will affect the focus of evaluation, the universal health insurance model pays more attention to fairness, and market-oriented model to pay more attention to efficiency. The evaluation subject will affect the establishment of the evaluation index system, and different evaluation main body will also appear different evaluation index system.
【作者单位】： 中国医疗保险研究会;
【基金】：国家自然科学基金重点项目(713300065)成果
【分类号】：F841.684
[Abstract]:The construction of medical insurance evaluation index system is an important link in the evaluation work. This paper first introduces the medical insurance evaluation theory in foreign countries, and studies the evaluation index system of medical insurance in the United Kingdom, the United States and Brazil, and finds that there are two main categories of the evaluation index system of medical insurance in foreign countries. One is to evaluate the efficiency of medical insurance, the other is to evaluate the fairness of medical insurance, but in practice there is a combination of efficiency and fairness, but the emphasis is different. Then, the related research on the evaluation index system of the domestic medical insurance is analyzed, including the evaluation of the basic medical insurance for urban workers, the new rural cooperative medical insurance and the urban residents' medical insurance. Finally, by comparing the domestic and foreign medical insurance evaluation, we can find that the object of assessment abroad is generally the whole medical insurance system, but most of the existing research in our country is the evaluation of a certain medical insurance system. With the development of the integrated medical insurance system, it is necessary to strengthen the research on the national basic medical insurance evaluation. Different types of medical insurance system will affect the focus of evaluation, the universal health insurance model pays more attention to fairness, and market-oriented model to pay more attention to efficiency. The evaluation subject will affect the establishment of the evaluation index system, and different evaluation main body will also appear different evaluation index system.
【作者单位】： 中国医疗保险研究会;
【基金】：国家自然科学基金重点项目(713300065)成果
【分类号】：F841.684
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