医疗保险付费方式的功能比较——县级公立医院补偿机制改革研究(六)

后付费方式、中付费方式和预付费方式是医疗保险的三种付费方式。不同的付费方式对医疗费用发挥不同的功能,对医疗机构产生不同的激励。比较三种付费方式的功能后得出结论:我国医疗保险付费方式将经历三个过程,第一个过程是后付费方式向中付费方式的转型,第二个过程是中付费方式向预付费方式的升级。医疗保险预付费方式的最大功能优势是建构医疗机构以成本为中心的经营模式,该经营模式主要通过两大机制发生关系转变:第一大机制是医疗保险的筹资机制将医疗服务供求双方的失衡关系转变为对等关系;第二大机制是医疗保险的预付费将医疗服务供、求、保三方的三角关系转变为直线关系。

Function Comparison in Payment Method of Medical Insurance

Post payment, middle payment and prepayment are the three payment methods of medical insurance. Different payment methods play different functions of medical expenses and different incentive to medical institutions. The author of the paper draws the conclusion by comparing the three payment methods. Payment methods of China＇s medical insurance go through three processes. The first one is the transition from post payment to middle payment while the second one is the upgrade from middle payment to prepayment. The biggest functional advantage of prepayment of medical insur- ance is to construct cost-oriented operating pattern in medical institutions. This operating pattern changes by means of two big mechanisms. The first mechanism is the financing mechanism of medical insurance whose function is to change the im- balanced relationship between supply and demand of medical service into peer relationship. The second one is that prepay- ment of medical insurance changes triangle relationship of supply, demand and insurance of medical insurance into line relationship.