城镇医疗保险费用控制研究——以社区卫生服务为视角-research on the control of urban medical insurance expenses —— from the perspective of community health services.docxVIP

11 11 州44414 摘要 摘要 我国城镇医疗保险制度自 1998 年建立以来，初步解决了医疗服务的筹资问 题。但在医疗保险费用控制方面仍然存在很大问题，尚未建立起有效的医疗保 险费用控制体系。凰然在改革中采取了很多尝试，但医疗保险费用过快增长的 趋势并未得到有效的渴制，需要进一步完善现有的医疗保险费用控制措施。 本文从理性经济人、公共地塘理论、委任·代理理论和信息不对称理论对医 疗保险费用过快增长的原因进行了分析。研究表明，医疗保险费用的过快增长 的原因主要有两大类:刚性的医疗费用增长和道德风险所致医疗保险费用不合 理的滥用。要控制住医疗保险费用过快增长的趋势，就必须控制住这两方面的 影响因素，即采取防泊相结合的措施，而现有的控制体系并没有体现出防治结 合的方针，因此，必须完善现有的控制体系。社区卫生服务作为最基层的医疗 服务体系，通过公共卫生服务可以预防医疗费用的产生，其低成本的医疗服务 都可以减缓医疗费用的刚性增长:在财政上采取收支两条线管理，切断了业务 人员的利益链，削弱了迫德风险产生的动机。所以，本文建议以社区卫生服务 为基点，先静现有的医疗保险费用控制体系，以控制医疗保险费过快增长。 关键词: 城镇医疗保险费用控制过快增长社区卫生服务 ABSTRACT ABS丁RACT 8ince its foundation in 1998，the urban medical insurance system in our country had elementarily solved the financing problem of medical service. However，there still are serious problems in controlling the medical insurance cost. Although many 刷empts 即e being taken in the reform，the overincreasing tendency of medical insurance cost has not be controlled efficiently. As a result，the current controlling measures of medical insurance cost should be further improved. ηle essay makes an analysis on the reasons why the medical insurance cost is increasing over-speed through the theories such as the Rational Economic Man，the Public Pond Theory，the Principal-Agent The。可and the Information Asymmetry ηleory. The research shows that the reasons why the over-increase of medical insurance cost can be generally divided into the following two types: 由e rigid medical insurance cost，and the reasonless misuse in medical insurance cost caused by moral hazard. To control the over-increasing tendency of medical insurance cost， the above mentioned two types of reasons must be controlled by adopting the measures that connects the prevention with the treatment. Yet the current control system does not show the policy with the combination of prevention and treatment ， therefore，the cuηent control system must be perfected. As the bottommost medical service system，the community health care service has two main ad