【摘要】：醫(yī)療保險(xiǎn)評(píng)估指標(biāo)體系的構(gòu)建是評(píng)估工作的重要環(huán)節(jié)。本文首先對(duì)國(guó)外的醫(yī)療保險(xiǎn)評(píng)估理論進(jìn)行簡(jiǎn)單的介紹,并結(jié)合英國(guó)、美國(guó)和巴西三國(guó)的醫(yī)療保險(xiǎn)評(píng)估指標(biāo)體系研究,發(fā)現(xiàn)國(guó)外的醫(yī)療保險(xiǎn)評(píng)估指標(biāo)體系主要分為兩類,一類是偏向于評(píng)估醫(yī)療保險(xiǎn)的效率,一類是偏向于評(píng)估醫(yī)療保險(xiǎn)的公平,但實(shí)際操作中都是效率和公平的結(jié)合,只是側(cè)重點(diǎn)不同。然后,對(duì)國(guó)內(nèi)醫(yī)療保險(xiǎn)評(píng)估指標(biāo)體系的相關(guān)研究進(jìn)行分析,主要包括對(duì)城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)、新農(nóng)合和城鎮(zhèn)居民醫(yī)療保險(xiǎn)的評(píng)估。最后,對(duì)比國(guó)內(nèi)外的醫(yī)療保險(xiǎn)評(píng)估可以發(fā)現(xiàn)國(guó)外的評(píng)估對(duì)象一般是整個(gè)醫(yī)療保險(xiǎn)制度,而我國(guó)現(xiàn)有的研究多是對(duì)某一項(xiàng)醫(yī)療保險(xiǎn)制度的評(píng)估;隨著一體化的醫(yī)療保障體系的逐步邁進(jìn),需要加強(qiáng)對(duì)全國(guó)基本醫(yī)療保險(xiǎn)評(píng)估的研究。不同的醫(yī)療保險(xiǎn)制度類型會(huì)影響評(píng)估的側(cè)重點(diǎn),全民醫(yī)保模式的更加關(guān)注公平,市場(chǎng)主導(dǎo)型的更加關(guān)注效率。評(píng)估主體會(huì)影響評(píng)估指標(biāo)體系的建立,不同的評(píng)估主體也會(huì)出現(xiàn)不同的評(píng)估指標(biāo)體系。
[Abstract]:The construction of medical insurance evaluation index system is an important link in the evaluation work. This paper first introduces the medical insurance evaluation theory in foreign countries, and studies the evaluation index system of medical insurance in the United Kingdom, the United States and Brazil, and finds that there are two main categories of the evaluation index system of medical insurance in foreign countries. One is to evaluate the efficiency of medical insurance, the other is to evaluate the fairness of medical insurance, but in practice there is a combination of efficiency and fairness, but the emphasis is different. Then, the related research on the evaluation index system of the domestic medical insurance is analyzed, including the evaluation of the basic medical insurance for urban workers, the new rural cooperative medical insurance and the urban residents' medical insurance. Finally, by comparing the domestic and foreign medical insurance evaluation, we can find that the object of assessment abroad is generally the whole medical insurance system, but most of the existing research in our country is the evaluation of a certain medical insurance system. With the development of the integrated medical insurance system, it is necessary to strengthen the research on the national basic medical insurance evaluation. Different types of medical insurance system will affect the focus of evaluation, the universal health insurance model pays more attention to fairness, and market-oriented model to pay more attention to efficiency. The evaluation subject will affect the establishment of the evaluation index system, and different evaluation main body will also appear different evaluation index system.
【作者單位】： 中國(guó)醫(yī)療保險(xiǎn)研究會(huì);
【基金】：國(guó)家自然科學(xué)基金重點(diǎn)項(xiàng)目(713300065)成果
【分類號(hào)】：F841.684

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