摘要
职工医疗保险的改革与发展政策的探索和制定 ,必须放在全国社会经济背景下考虑。作为一种新的医疗制度 ,医疗保险的出现将涉及社会许多方面的利益 ,如果社会各方和医疗保险机构的期望相互矛盾、无法调和的话 ,就体现为社会震动和医疗保险的实施阻力。文章以此为出发点 ,重点探讨了在职工医疗保险进程中 ,医疗保险机构面临的与社会各方潜在的矛盾 ,医疗保险机构的运作难点与医疗保险制度的目的的矛盾 ;医疗保险机构政策制定能否建立在基础性的管理理念上 ,即协调和兼顾各方利益 ;医疗保险人群内部的心理感受反差 ;医疗保险机构解决原有社会性卫生问题和减少新问题的能力 ;医疗保险对社会人口的医疗需要满足程度的重新调整 ;医疗保险对卫生资源的总体投入、配布和利用的影响 ;医疗保险改革促使区域卫生规划职能和内涵的演变 ;医疗保险重组和改革运作机制的问题 ;医疗服务结果 ,如 ,服务公平性、适宜性、可及性、利用率、质量、效率、效果和健康结果的重新评估问题。而这些问题最终的严重程度如何 ,将与医疗保险部门的协调与管理能力直接相关。
Policies concerning the reform and development of medical insurance(MI) for workers and staff members must be explored and formulated with the countrys socio economic situation taken into consideration. The advent of MI as a new medical system will touch upon the interests of many social aspects. If there exist irreconcilable contradictions in the expectations of various social aspects and MI institutions, then these contradictions will emerge as social upheavals and obstructions to the implementation of the MI system. Proceeding from this point, the paper focuses its discussion on the following issues that have appeared in the course of effecting MI for workers and staff members. ①Potential contradictions with various social aspects as confronted by MI institutions and contradictions between operating difficulties of MI institutions and the goals of the MI system. ②The question of whether MI institutions will base their formulation of policies on basic management concepts, coordinating and giving consideration to the interests of various aspects. ③Contrast in the psychology of the masses taking MI. ④Capability of MI institutions to solve existing health related social problems and reduce the occurrence of new problems. ⑤Readjustment of the satisfaction extent of the masses regarding their medical requirements as caused by MI. ⑥Effects of MI on the total input, allocation and utilization of health resources. ⑦Changes in the functions and connotations of regional health planning as induced by MI reform. ⑧Problems arising from MI regrouping and the reform of operational mechanisms. ⑨Reevaluation of the results of medical services, such as service fairness, appropriateness, accessibility, utilization ratio, quality, efficiency, outcome, and health results. The degree of seriousness of these issues is in the final analysis directly related with the coordination and management capability of MI institutions.
出处
《中华医院管理杂志》
北大核心
2000年第1期7-12,共6页
Chinese Journal of Hospital Administration
关键词
职工医疗保险
中国
实验
医疗制度
Insurance, Medical, Workers and staff members
Implementation
Problems
