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引用本文:宋大平,赵东辉,汪早立.医疗保障与医疗服务统筹管理:国际经验与中国现状[J].中国卫生政策研究,2012,5(8):49-55
医疗保障与医疗服务统筹管理:国际经验与中国现状
投稿时间:2012-03-31  修订日期:2012-07-20  PDF全文浏览  HTML全文浏览
宋大平1, 赵东辉1, 汪早立1
卫生部新型农村合作医疗研究中心
摘要:统筹管理医疗保障和医疗服务,符合医疗保障制度的发展要求和特殊性。医疗保障管理体制在平衡保障基金、医疗服务提供和医疗服务监管三个核心要素时,形成了分离模式、半统筹模式和全统筹模式三种模式。不同医疗保障制度类型的国家,其管理体制在现阶段都出现向全统筹模式迈进的倾向。中国基本医疗保障制度下,全统筹模式比分离模式表现出更多的优越性。中国应建立统筹管理医疗保障与医疗服务的卫生行政管理新体制,整合基本医疗保险经办资源,并推行卫生行政部门监管机制改革。
关键词:医疗保障  医疗服务  统筹管理
Integrated management of medical security funds and medical services: International experiences and China’s practices
Abstract:Integrated management of medical security funds and medical services conforms to characteristics and requirements of medical security schemes. Three models such as the Separate Model, the Half integrated Model and the Fully integrated Model, are shaped when three elements such as medical security funds, medical service delivery and medical service supervision, are weighed and chosen in establishing the administrative structure of medical security systems. A tendency of choosing the Fully integrated Model is shown in different types of medical security systems worldwide. The Fully integrated Model has shown more advantages in China than the Separate Model. A new health administrative system featured by integrated management of medical security funds and medical services should be established, with integrated executive resources and reformed supervising mechanism of health authorities.
Key words:Medical security  Medical services  Integrated management
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