摘要
国家医疗保障局的成立使得医保治理的重要性凸显出来。作为医保治理的重要方面,通过医疗保险第三方购买控制医疗费用增长在各地不断被实践。在对医保控费动力的解释中,"倒逼改革"和"资源优势"作为两种截然不同的论点同时出现。本研究检验了两种论点在医保控费动力机制中的真实性,并探索其地区差异。通过省际面板数据分析,本研究发现医保基金结余低或医保行政经费高都是抑制医疗费用增长的重要因素。各省在"倒逼改革"和"资源优势"方面存在四种类型——资源驱动型、危机驱动型、双重驱动型和非资源或危机驱动型。政府未来应改革医保治理激励机制,加强医保第三方建设。
The establishment of the National Health Insurance Bureau highlights the governance in health insurance. As an important aspect of the governance in health insurance,medical cost containment through strategic purchasing has been frequently practiced in localities. The ideas of the ＂ pressure-induced reform＂ and the ＂ power of resources＂ comes out as two various kinds of explanations of the dynamics of medical cost containment through strategic purchasing. This study examines the validity of the two ideas and explores their regional variations. Using panel data at provincial level,this study finds that either low surplus of health insurance funds or high operational budget for insurance agencies leads to medical cost containment. There exist four types of dynamics of medical cost containment including resource-driven,risks-driven,dual-power-driven,and non-resource-and-risks-driven ones. We suggest that the government reforms the incentive structure for the insurance purchasers and promote third-party purchasing.
出处
《社会保障研究》
CSSCI
2018年第3期31-39,共9页
Social Security Studies
基金
国家社会科学基金青年项目"医疗费用增长与社会医疗保险可持续性研究"(16CSH032)的资助
关键词
医疗保险
医疗费用控制
倒逼改革
资源优势
医保治理
health insurance
medical cost containment
pressure - induced reform
power of resources
governance in health insurance
