三级医院医疗保险管理的现状与思考

医疗保险制度是目前世界上应用的相当普遍的一种卫生费用管理模式。目前，三级医院是医疗保险参保人的首选医疗机构，承担着基本医疗保险的主要任务。2005年北京市承担基本医疗保险住院费用发生情况：三级医疗机构69家，出院参保病人21.76万人次，占出院参保病人总数的68.7％；     

日本医疗保险制度的改革计划

本简要地介绍了日本政府对现行医疗保险制度提出了改革内容，包括建立医生退休制度，保险费用支付比例和药品价格的调整等。     

美国医疗保险药物治疗管理的介绍

目的:介绍美国药物治疗管理的主要内容.方法:利用文献材料采用综述方法介绍美国药物治疗管理的内容.结果:自2006年以来,美国药物治疗管理改变了药品的使用模式,使之演化为一个控制费用并促进医疗质量的更有效的工具.结论:美国药物治疗管理对我国医疗保险部门的工作,特别是医疗保险制度和药品安全监督工作具有借鉴意义.     

医疗保险定点医疗机构与参保人的权利和义务

自1998年底国务院颁布《关于建立城镇职工基本医疗保险制度的决定》之后，医疗保障制度改革在全国各地广泛开展。根据我国医疗保障制度改革遵循的“低水平、广覆盖、共同负担、统帐结合”的基本原则，尽快明确定点医疗机构与参保人的权利和义务，以维护定点医疗机构和参保人双方的合法权利，是一个十分迫切的问题．     

医疗保险计划与实施

随着城镇职工医疗保险制度的建立,医院面临诸多问题。针对医保工作存在的重点问题,制定目标,有效实施,使医院获得了社会和经济效益的双赢。     

联邦儿童医疗保险计划

美国政府于1997年制定的联邦儿童医疗保险计划是自1965年创立Medicaid以来美国政府对贫困儿童的医疗保健进行的最大投资。介绍了联邦儿童医疗保险计划制定的时代背景、实施概况、抗排挤措施和效果,以及实施的总体效果,为我国相应保险政策的制定提供参考价值。     

医疗保险体制下日本处方药品的发展

日本是一个制药业非常发达的国家，它的整个制药业，尤其是处方药品的发展一直受到医疗保险体制的影响，它的历史对于我国如何搞好医疗保险体制改革，正确引导药品市场的发展会有一定的启发作用。     

联邦儿童医疗保险计划

美国政府于1997年制定的联邦儿童医疗保险计划是自1965年创立Medicaid以来美国政府对贫困儿童的医疗保健进行的最大投资.介绍了联邦儿童医疗保险计划制定的时代背景、实施概况、抗排挤措施和效果,以及实施的总体效果,为我国相应保险政策的制定提供参考价值.     

不能忽视政府在医疗保险制度改革中的作用

随着医保改革的深入,政府在医疗保险中大包大揽的做法在改变。然而,医疗保险的社会公益性特点,医疗服务消费的特殊性,社会主义医疗卫生事业的特殊属性,决定了医保改革离不开政府的作用。政府在医保改革中应加快医保立法步伐,加大对医疗卫生事业的投资,加强对医保的检查、监督和管理,尽力为医保改革创造良好的宏观经济环境。     

荷兰医疗保险制度的改革

荷兰是君主立宪制国家。尽管荷兰的卫生制度带有政治和宗教因素,但政府对荷兰卫生政策负有全面责任。荷兰和大多数工业化国家一样,实行的是国家（政府）医疗保险、社会医疗保险和私人医疗保险相结合的模式,其资金的筹集主要采取工资税（属于专项税收）和雇主、个人缴费相结合的形式。现行的卫生体制是以公共和私人混合型为特点,许多荷兰人认为这一混合型的卫生保健制度集英国的社会职责、斯堪的那维亚国家的公共体制和美国的企业效率为一体,十分适合荷兰的国体。医疗服务由私人或非营利性医院提供。卫生保健支出虽高于大多数工业化国家…     

Quality, cost, and coverage: examining the federal employees' health insurance plan

In this article, the author uses a survey of more that 90,000 members of the Federal Employees' Health Benefits Plan (FEHBP) to examine a population whose health care is provided by a regulated market unlike any other market in the United States. Within the FEHBP, the government defines the market and brings buyers and sellers together, guaranteeing each much more security than either is able to obtain in the open market. For the sellers, there is the promise of having a customer for at least a year. For the consumer, there is the promise of being treated like any other customer in spite of preexisting illness or other special health care needs. To assess the success of this plan, the author examines how the consumers perceive the quality of their plans and their overall level of satisfaction and then compares that information to perceived quality and satisfaction among consumers in the open market.     

Introduction of disease management programmes in Germany as reflected by differing interests of health insurance companies and the federal association of statutory health insurance physicians

On 1st January 2002 a law was enacted by the German Federal Government reorganising the reinsurance pool known as the "risk compensation scheme" (RSA) of the German health insurance system. This enactment contemplates a gradual restructuring of the RSA to shift from a system that considered only certain demographic criteria to one that reflects actual morbidity rates, with the shift to be phased in before full implementation by 2007. The enactment also introduced disease management programmes (DMP) for patients with certain chronic illnesses. Insurance companies will now receive additional payments from the RSA for patients with a chronic condition who are enrolled in a DMP. The intent is to improve the poor medical care for chronically ill patients in Germany - as had been stated by the advisory council of the Concerted Action in Health Care - and to reduce the natural tendency of insurance companies to prefer young healthy members over chronically ill patients. Possible consequences of the legal changes are discussed from the point of view of the various insurance companies as well as the Federal Association of Statutory Health Insurance Physicians.     

On being new to an insurance plan: health care use associated with the first years in a health insurance plan

BACKGROUND We wanted to compare health care utilization and costs in the first year of being in a health insurance plan with those of subsequent years.     

管理型医疗保险方案与补偿型健康保险方案的比较研究

管理型医疗是已被国外普遍证实的控制成本、提高保险公司利润的一种卓有成效的保险方案.它要求保险人与保险计划的提供者更多的了解和掌握评价医疗服务的技能.它通过市场竞争和选择与医疗服务供方实现风险分担,由特定的组织结构和管理手段达到控制成本的目的,并取得几乎没有差别的医疗质量.传统的补偿型健康保险方案采用的是按服务项目付费的事后理赔计划.由于按服务项目付费的相关医疗决策几乎完全由医生和患者进行,且技术上很难确定合理的服务总量,这就在很大程度上增加了难以控制的道德风险.文章介绍了管理型医疗的定义及主要组织形式,着重从支付方式、医疗质量、合作医疗机构的选择等3个层面与传统的补偿型健康保险方案做了全面深入的比较研究.     

Employee demand for health insurance and employer health plan choices

Although most private health insurance in US is employment-based, little is known about how employers choose health plans for their employees. In this paper, I examine the relationship between employee preferences for health insurance and the health plans offered by employers. I find evidence that employee characteristics affect the generosity of the health plans offered by employers and the likelihood that employers offer a choice of plans. Although the results suggest that employers do respond to employee preferences in choosing health benefits, the effects of worker characteristics on plan offerings are quantitatively small.     

Employment-related health insurance: federal agencies' roles in meeting data needs

Employer-sponsored health insurance accounts for almost one-third of all health care spending. As health care cost growth accelerates affecting the availability of employer-sponsored insurance and depth of coverage, the importance of timely and accurate information for measuring and monitoring these changes and formulating policy options increases. Identifying a growing gap between the need for and availability of data to inform policy on employment-related health insurance issues, the Office of Management and Budget (OMB) established a committee of Federal agency representatives to evaluate and advise data collection efforts. This article reports on the committee's current efforts, focusing on evaluation of results from the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) and the National Compensation Survey (NCS).     

蒙古国健康保险体制发展简介

蒙古国面积为156500平方公里，人口为240万（2000年），其中20％的人口属于半游牧民族，给卫生服务的提供带来很大的困难。蒙古国曾长期实行计划经济，在计划经济时期，蒙古国在全国范围内建立了以四级卫生服务网络为基础的卫生服务体系：网底是助理医师，往上依次为医疗所及各级医院。蒙古国将5％的GDP（或是8％的政府预算）用于为居民提供免费的初级卫生保险服务，保证每个蒙古国居民（无论住得多远）均可以得到最基本的初级卫生保健服务。     

The impact of health insurance plan type on satisfaction with health care

Because many previous studies of satisfaction with health care used unreliable measures, failed to consider all major health care plan choices, or did not include a broad population, this study used a reliability-tested multi-item instrument on individuals in HMO, PPO, and fee-for-service insurance plans who were randomly drawn from a national population. The findings regarding satisfaction were that differences existed among the plan members' satisfaction on the dimensions of access to care, availability of resources, and financial aspects of care.