基于竞争的合作:美国责任制医疗组织发展中的利益协调与启示

医疗资源的整合是利益重新调整的过程,只有平衡好各方利益,才能实现医疗资源的有效整合。责任制医疗组织(ACOs)是美国最热门的医疗模式。ACOs组建和运行中,在发挥市场配置资源的基础上,政府发挥了管理与引导作用。政府通过共享节余和风险分担来激励医疗服务提供者加强合作,强化对医疗质量的监控并赋予患者就医的自由选择权,加强对患者的保护,并开展反垄断调查,赋予ACOs竞争压力。借鉴ACOs的发展经验,我国建立整合型医疗服务体系,应在发挥市场配置资源的基础性功能基础上,有效发挥社会医疗保险的购买功能,强化对医疗机构和医务人员的激励、引导、约束和监督。

Competition-based cooperation: Reconciliation of interests in Accountable Care Organizations in the United States

The integration of medical resources is essentially the process of readjusting interests, and only when the interests of all parties are balanced, the effective integration of medical resources will be achieved. ACOs are now the most popular medical model for integrating medical resources in the United States. In the formation and operation of ACOs, the government has played a role of management and guidance on the basis of market allocation of resources. By the way of savings and risks sharing, the government encourages medical service providers to enhance collaboration and coordination, and strengthening patient protection by improving the medical service quality control, empowering patients'' freedom of choice of health care suppliers, and launching anti-monopoly investigations for the purpose of putting a competitive pressure on ACOs. The development of ACOs might have certain reference significance for China to integrate medical resources. To establish an integrated medical care system in China, on the basis of the basic role of the market allocation of resources, the department of social medical insurance should effectively play the role of medical insurance purchaser, strengthening encouragement,guidance,and restraint of and supervision to medical institutions and medical staff.