美国管理式医疗保险与传统医疗保险的比较与借鉴

管理式医疗保险正在逐渐成为美国主流的医疗保险模式.它与传统医疗保险的不同点在于:二者的经济模型不同;消费者(患者)选择供给者的自主性不同;医生的经济风险不同;对利用评估的影响不同;对医生临床决策的影响不同.管理式医疗只能从成本约束的角度影响或限制医生的医疗自主权,并不能从根本上代替医生做临床决策.在管理式医疗模式下,医生的执业风险与消费者的健康利益都受到了明显的负面影响,同时,由于市场本身的原因,它正面临着越来越难的发展局面.管理式医疗在我国的运用应慎重.

Reference of and comparison between managed care and traditional medical insurance in America

Managed care insurance is growing into the mainstream health insurance model in the United States. The differences between this and the traditional health insurance lie in their economic model, their autonomy of consumers in their choices of suppliers, their economic risk exposure for clinicians, their effect on utilization review and their impact to clinical decision-making. Managed care can only, in terms of cost constraints, affect or limit the autonomy of medical decision, instead of making decisions in lieu of clinicians. Under managed care, both the professional risk of clinicians and health benefits of consumers are exposed to obvious negative influence. In the meantime, the model is facing growing difficulties in the future for the market itself. In this regard, prudence is required to introduce managed care in China.