摘要
在"全民医保"即将建成的格局下,我国基本医疗保险经办机构本应成为积极而强势的医疗服务购买者。但目前我国基本医疗保险经办机构仍旧是一个"消极的医疗费用支付者",其具体职能离真正意义上的医疗服务购买者相去甚远。这也导致其无法发挥抑制医疗机构滥用专业优势的功能,并削弱了其所承载的医疗社会化的目标。因而有必要借鉴美国等医疗市场发达国家的"管理式医疗"经验,将我国基本医疗保险经办机构定位为医疗服务购买者,对现有的基本医疗保险经办机构进行公益性改革,并实现其职能转型,使其成为一个选拔合格医疗机构、参与医疗行业标准化诊疗流程和病种制度建设、对患者反馈信息进行分析和评价、控制医疗费用上涨并监督医疗服务质量的职能部门。
Since the Basic Medical Insurance is to cover all citizens and farmers,China＇s Basic Medical Insurance Agencies should become positive and powerful purchasers of medical services.However up till now they are still ＂negative payers of medical services＂ with poor functions far from the real-sense purchasers,which have failed to prevent the medical service agencies from abusing their professional advantages thus have wakened the goal of medical socialization.Therefore,it is necessary to learn from the ＂Managed Medicare＂ experience from the United States in order to define China＇s Basic Medical Insurance Agencies as purchasers of medical services and to carry out the reform for public welfare.The functions of the Basic Medical Insurance Agencies should be converted to such aspects as selecting qualified hospitals,participating in setting up standard process for medical treatment and development of Diagnosis-Related Group（DRG）,analyzing and evaluating the feedback information from patients,controlling improper medical cost and supervising the quality of medical service.
出处
《北方法学》
CSSCI
2012年第1期154-160,共7页
Northern Legal Science
基金
中国法学会部级法学研究课题"公平分配制度法律保障研究"(项目编号CLS-A1002)的阶段性成果
关键词
基本医疗保险经办机构
付费者
医疗服务购买者
Basic Medical Insurance Agencies
payers of medical services
purchasers of medical services
