医疗保险中的风险管理.pdfVIP

解监牢医陇管理杂户 Hosp 八d;i;U ëh~ PLA 2003 日町; 10(6) J • 521 • 形辈[J]解腊望在医院管理是与嚣 ， 2002.9(2) ，! B1 ι182 [6J 班一池-人力资源管现教梅[MJ，北京:北京大学出版批.1999 [4J 酷立群，何 草.~疗服务价梅管碟的经济学思考LJ 工解放军 l …8 阪院管现荣志‘2002. 驯的 :389…390 [5J 果d 侈，帽雄班.!!I 宁因防投赞论[M]. 椭州·海风出版社唱 〈本:x编幌冯玉带) 2002 l 221 吨261 ~押保险中的风险管理 曹阳，陈洁，曹建立 (复旦大学公共卫生k学院医院管E理学教研絮，上海 2(0032) 文.编号，J008 - 9985 (2003 )06 …0521 叩0523…03 Jt献标识确，A 关键诩E 医疗保险;风险管理e 策略，]日生政策 中团分樊每，R 197. 32 捕 裹:医疗保除制度中的风除霄理策略包括对痰病风险的识别态度.伯测和l重巅痰病风险的技术，jlI;择疾病风险的管磁方 式.以且对疾病风险管理她泉的评价和认识.它附于促进卫生资腻的公平分自己和有效利用有重婆的愈义.卒X~吉齿隘疗保险 制度中的三角阴方关系对国内外医疗保险制度中宏观、中观和微观层次的风除管现策略进行了概要分析，指出了我罔原疗 保险制度改革在中存在着对市场功能的周限性认识不足、基层医疗机构的预防功能日益萎缩和缺乏对医院选行监督和制约的 有娘机制等问题b 提出了将医疗保险逐步从社会保险中分化出来，并从筹资J跑量、基郁隘疗服勤的界定、保险金的偿付比例和 限顿等方面确保基本l!i:疗的保障在平等方案及下一步的研究戴点。 Risk Management in Medical Insurance CAO Yang. CHEN Jie. CAO Jian-wen Departmenl 01 Hospital Management. School 01 Public Health. Fu- dan University , Shanghai 200032) Abslract: Risk management strategy of medical insurance încludes recognition attitude , evaluation and as- sesstnent technology ，附lectìon of management methods of dísease risks , and cognitïon and review of rìsk management eHect. 1t is important for promoting distribution equity and effective utilization of health re- sources. The article described the relationship among the three angles and four aspects in medical insur- ance system. explained the risk management strategy and summarized different strategies of representative countries. 1t also pointed out main problems in medical insurance systern reformatïon of China , provided feasible schemes for relevant problems and indicated the research direction to solve them. Key words: medical insurance; rísk management; strategy; health policy