美国医保经办管理费用水平探究

吕兰婷; 王知

doi:10.19546/j.issn.1674-3830.2023.2.009

中国医疗保险 ›› 2023, Vol. 0 ›› Issue (2) : 59-63. DOI: 10.19546/j.issn.1674-3830.2023.2.009

国际（地区）比较

美国医保经办管理费用水平探究

吕兰婷^1,2, 王知²

作者信息 +

Research on the Medical Insurance Management Expenses in the United States and Its Enlightenment

Author information +

文章历史 +

摘要

美国作为商业医疗保险体系发展较为成熟的典型国家,其医保管理费用能够较好地反映商业保险公司经办效率情况。本文基于对美国各类医保项目管理费用相关数据的整合统计,分析总结商业保险公司管理费用水平特点和原因,以期为我国合理设计医保经办管理费用投入、完善医疗保险经办管理服务体系建设提供一些实践信息参考。

Abstract

As a typical country with a mature commercial medical insurance system, the United States' medical insurance management costs can better reflect the efficiency of commercial insurance companies. Based on the integrated statistics of the data related to the management costs of various medical insurance projects in the United States, this paper analyzes and summarizes the characteristics and reasons of the level of management costs of commercial insurance companies, with a view to providing some practical information for China to reasonably design the investment of medi cal insurance management costs and improve the construction of medical insurance management service system.

导出引用

吕兰婷, 王知. 美国医保经办管理费用水平探究[J]. 中国医疗保险. 2023, 0(2): 59-63 https://doi.org/10.19546/j.issn.1674-3830.2023.2.009

Research on the Medical Insurance Management Expenses in the United States and Its Enlightenment[J]. China Health Insurance. 2023, 0(2): 59-63 https://doi.org/10.19546/j.issn.1674-3830.2023.2.009

中图分类号： F840.684 C913.7

参考文献

[1] 严娟.提升医保治理能力,加强经办管理与公共服务建设[J].中国医疗保险,2021,No.159(12):17-18.
[2] 华颖. 中国医疗保险经办机制:现状评估与未来展望[J].西北大学学报(哲学社会科学版),2020,50(03):157-166.
[3] 刘凯,和经纬.激励机制、资源约束与监管成本——医保经办机构组织能力影响医疗费用增长的实证研究[J].公共行政评论,2018,11(02):114-136+192.
[4] 朱梓荣,颜建周,邵蓉.美国基本医保委托经办管理制度研究及其对我国的启示[J].中国药房,2020,31(15):1793-1798.
[5] HELLANDER I, HIMMELSTEIN D U, WOOLHANDLER S.Medicare overpayments to private plans, 1985-2012: shifting seniors to private plans has already cost medicare US$282.6 billion[J]. Int j health serv, 2013,43(2):305-319.
[6] 华颖. 中国医疗保险经办机制:现状评估与未来展望[J].西北大学学报(哲学社会科学版),2020,50(03):157-166.
[7] 李春厚,龙微月,刘阳,等.美国医疗保险承包商管理对我国基本医保经办管理的启示[J].中国卫生经济,2018,37(12):113-116.
[8] 宋大平,崔雅茹.商业保险机构参与基本医疗保险经办服务:国际经验、国内现状与机制完善[J].中国卫生经济,2019,38(01):27-31.
[9] 李吏,华迎放.医保委托商业经办管理问题探析[J].中国劳动,2015,No.355(07):8-12.