摘要
医疗保险中医、患、保三方在追求各自利益目标的过程中存在博弈关系,按病种分值结算兼顾医疗机构、患者和医保经办机构三方利益,既形成激励约束机制,又妥善处理例外情况,并着力保障参保患者权益,使三方各取所需,和谐共赢,共同推进医保事业可持续发展。
It is competitive relationship among hospitals, patients and medical insurance in the pursuit of their own interests goals. Whereas, the insurance settlement by disease score considers the interest of three parties. It forms incentive mechanisms, can properly handle the exception, but make great effort to ensure the rights and interests of the insured patients. It meets three parties’ needs and brings harmonious win-win effects. As a result, it can make them jointly promote sustainable development of medical insurance.
出处
《中国医疗保险》
2015年第4期25-27,共3页
China Health Insurance
关键词
支付制度改革
病种分值结算
激励约束
payment system reform
settlement by disease score
incentive constraint
