摘要
风险调整机制有助于分担保险方的基金风险、实现医保待遇的一致性。文章对瑞士、荷兰、德国、澳大利亚和爱尔兰等国采取的风险调整机制做法进行综述,并总结出如下特点:建立风险调整机制是实现医疗保险基金平衡和一致性原则的重要手段;风险调整机制不仅适用于强制性医疗保险市场,也适用于自愿性医疗保险市场;建立风险调整机制,有助于促进保险公司之间开展内涵竞争、为参保人群提供质量更好和效率更高的服务;风险调整机制正由回顾性向前瞻性与回顾性相结合转变;这些发现可为进一步完善我国的基本医疗保险制度提供借鉴。
The practice of risk adjustment mechanism in Switzerland, Netherland, Germany, Australian and Ireland was sum- marized and characterized as follows. Risk adjustment mechanism is an important measure to share risk among the insured and a- chieve solidarity among different health insurance systems. Risk adjustment mechanism can be adopted by countries with compulso- ry medical insurance system or voluntary medical insurance system. Risk adjustment mechanism is helpful to promote competition among the insured and make them provide better and efficient services. Risk adjustment is on the transition from retrospective to prospective mechanism. These findings can provide some references for improving basic medical insurance systems in China.
出处
《中国卫生事业管理》
北大核心
2014年第4期264-268,共5页
Chinese Health Service Management
关键词
竞争性
医疗保险
风险均等化
一致性
competition
health insurance
risk adjustment
solidarity.
