【作者】 潘虎；

【导师】 杨燕绥；

【作者基本信息】 清华大学 ， 公共管理， 2003， 硕士

【摘要】 近年来，由于经济全球化、人口老龄化、健康观念的转变以及疾病的新类型等因素，使各国的医疗保障制度都面临巨大的挑战。本文从种概念和属概念的关系入手，对现行的各种医疗保障制度按照支付方划分为国家保障、第三方付费和个人储蓄三种类型。这种划分有助于剖析医、患、保三方的博弈关系，进而辨别在不同的医疗保险制度下和一个医疗保险制度的不同阶段，这三方关系是如何演变的。管理型医疗是一个综合概念，是一种集医疗服务提供和经费管理为一体的医疗保障模式，它协调了医、患、保三方的关系，解决了逆向选择和医疗信息不对称的难题，从而大大降低了医疗费用。各国在面临医疗费用快速上涨、财政不堪重负的困境下，政策选择都不约而同地走上了管理型医疗的道路。医疗服务是公共产品，具有福利性和公益性，政府依靠它来保持社会稳定和维护公平。同时它又是有限的公共物品，具有消费的“拥挤性”，政府必须从一定程度上控制医疗消费的过快增长。本文分析了代表国家保障制度模式的英国NHS系统、代表第三方付费制度模式的德国法定医疗保险和代表个人储蓄制度模式的新加坡储蓄医疗近年来借鉴管理型医疗所采取的政策措施。 中国正处在转型期，传统的福利型公费医疗和劳保医疗正在向社会医疗保险过渡，政府角色具有更多的保险人特征，社会弱势群体通常处于这个保护体系之外。1998年开始实行的定点医院和定点药店管理也属于管理型医疗。本文采用实地调研的方法对中国医疗保险改革的试点城市镇江进行了调研，运用评价指标从覆盖率、缴费率、医疗可及性和经济负担程度等方面对镇江的社会医疗保障制度作了初步评价。这一新的管理医疗模式将为中国的医疗保险迈向更高的健康保障模式提供契机。这部分分析和评价是本文的关键和核心内容。在分析了中国医疗保障的改革趋势后，本文提出中国式管理型医疗要建立以健康公平为价值取向，科学付费机制为基础的多层次全民社会医疗保障体系。更多还原

【Abstract】 In the new millennium, the medical security of all the countries are facing the kinds of challenges that come from economical globalization, aged population, renewal of health concept and new types of diseases.The author classifies all the existing system of medical insurance by the principle of type and attachment into three categories, which are paid by the government, paid by the third party and paid by the individual’s savings. This classification will play as a helpful instrument to explore the game relationship among the doctors, patient and insurers, which in turn identify how this relationship changed accordingly under the different systems of medical security as well as the different stage of the same one.Managed care, which is classifies as a general concept, is a medical security model that bonds the supply of medical services and management of security funds. Because of coordinating the relationship among those three parties and solving the problem of converse option and medical information dissymmetry, it has greatly deduced the medical expenditure. Therefore, almost all the countries are turning to be on the road of managed care when confronting the problems of fast rising of medical expenditure and heavy load of finance.Medical service belongs to the public goods that have nature of welfare and commonweal. The government depends on the well running of it to maintain social steadiness and equity. On the other hand, it is a limited one, having the character of consumption huddle, which is necessarily controlled in a certain by the government to avoid the increasing expenditure of medical treatment. The author analyzes the managed care character of the British National Health System that represents the type of national security, the German legal medical insurance that represents the type of the payment made by the third party and<WP=5>the Singapore medisave that represents the type of the payment made by individual. China now is in the transferring time. The Chinese government is playing as a big insurance company during the systemic transferring process of turning from medical welfare based on public and enterprise expense to medical insurance supported by social members. Generally speaking, the venerable of the Chinese society are not in the protection of the medical security.The policy of fixed hospital and drugstore that implemented from 1998 belongs to the managed care. The author makes spot investigation in the pilot reforming city, Zhenjiang, to primarily appraise the performance made by the local medical security department by using such evaluating index as coverage rate, paying rate, medical accessibility and economic burden rate. This new type of managed care will provide an opportunity for the further development of Chinese medical security from treatment insurance to health security. This part of analysis and appraisal forms the key points of the article. Following the analysis of the tendency of Chinese medical insurance reform, the author points out that it is feasible for China to build a multi-arrangement and nationally-covered medical security system that are based on the value of health equity and scientific payment mechanism.更多还原