摘要
全民医保背景下,如何通过完善定点医院医保管理来提升医保基金使用的质量和效率,是医保基金有效供给和费用控制中急需解决的现实问题。本文基于医保患者(参保人)的视角,从患者感知与主观选择的角度提出四个研究假说,尝试探讨参保人对定点医院医保管理水平的评价及影响因素。研究发现,费用膨胀、信息壁垒、住院类别对定点医院医保管理满意度的影响最为显著;患者感知比主观选择对医院医保管理满意度的影响更为强烈;医保患者对不同类型医院医保管理满意度的评价及其影响因素有显著差异。引导参保人合理选择住院类别、实施差异化的定点医院监管策略、发挥商业保险机构优势治理费用膨胀、畅通信息传递是提升参保人对医保管理满意度的有效选择。
Under the background of universal social medical insurance coverage,a pressing issue for achieving ef- fective supply and cost control of medical insurance funds is how to improve the quality and efficiency of medical in- surance fund usage by way of perfecting the management of medical insurance schemes in designated hospi- tals. Based on the perspective of perception and subjective choice of patients in medical insurance system, the paper proposed four hypotheses and attempted to discuss their attitudes towards the management of medical insurance in designated hospitals and influencing factors. The study found that soaring medical expenses, information barriers and hospital ratings had the most impacts on the satisfaction towards management of medical insurance scheme in desig- nated hospitals;patients＇ perception were more powerful than their subjective choices in shaping their satisfaction levels;for hospitals with different ratings, there were significant differences in patients＇ satisfaction levels towards medical insurance management and the influencing factors varied, too. Therefore, we should guide patients in the medical insurance system to choose hospitals sensibly, implement differentiated supervisions on designated hospi- tals, mobilize the advantages of commercial insurers to deal with the medical expenses inflation and guarantee the smooth flow of medical information.
出处
《保险研究》
CSSCI
北大核心
2015年第6期118-128,共11页
Insurance Studies
基金
国家社科基金项目"我国社会保险调节收入分配的传导机制及政策效果研究"(项目编号:13XSH018)
四川省社科基金重点项目(项目编号:SC12A010)
中央高校基本科研业务费专项资金资助项目(项目编号:JBK1407148)
