摘要
社会医疗保险制度在运行中,涉及医疗服务提供方、医疗服务需求方、医疗保险机构等多个主体,目前社会医疗保险的费用支付方式使医疗保险机构、参保人和医疗机构三方形成三角支付关系、利益竞争关系和信息不对称关系,容易导致医疗保险机构费用控制能力降低,造成医疗保险基金浪费。医疗保险中的费用控制问题归根到底是调整医疗保险机构、医疗机构和参保者之间的利益关系。除了要运用传统的行政、经济、法律等手段规范制度、严格监督管理外,通过创新医疗保险模式,可以有效地重新整合三方关系,改变医疗保险机构在三者关系中的被动地位,提高其费用控制能力,从而实现社会医疗保险资源的合理、高效、规范利用,促进社会医疗保险事业健康发展。
The expense control is a major problem that troubles the reformation of medical insurance system. To analysis the expense control of social medical insurance from competition relationships of interests, relations of information strength and constraint relationships of expense control of three parts can strengthen medical insurance institutions＇ principal role in the operational process of medical insurance. By means of medical services provided by the medical insurance institutions, the medical service organizations founded by enterprises or groups, medical expenses managed by medical service providers can curb the cost of medical insurance.
出处
《河南师范大学学报（哲学社会科学版）》
CSSCI
北大核心
2014年第1期85-87,共3页
Journal of Henan Normal University(Philosophy and Social Sciences)
关键词
三方关系
社会医疗保险
费用控制
Trilateral relations
Social medical insurance
Expense control
