医保制度对医患关系影响的关键维度分析——基于中国、加拿大比较研究

摘要

目的 探讨医保制度对我国医患关系产生影响的关键维度,通过对比中国与加拿大不同医保制度设计与要素安排及其对医患关系的影响,提出以医保制度重构为契机的医患关系改进政策建议.方法 采用定量与定性相结合的分析方法对中国和加拿大的相关医保制度安排进行对比并提出合理政策建议.结果 中国与加拿大在筹资机制、支付机制、报销机制、基金运行管理机制、立法监督机制以及异地就医等医保要素上所作出的不同制度安排,是造成两国医患关系不同结果的关键制度根源.结论 构建和谐的医患关系绝不仅仅是医生与患者个人的责任,医保制度在其中起着不可忽视的作用.国际经验表明,合理的制度设计和要素安排能够为医患关系提供良好的制度环境.%Objective To discuss the critical path of the effect of China's health care system on the doctor-patient relationship.By comparing the health insurance system design and its influence on doctor-patient relationship between China and Canada,to provide evidence support for reconstruction of an improved relationship between patients and health care providers.Methods Doing a comparative study of the design of basic health insurance system between China and Canada,and proposing reasonable political suggestions.Results The different arrangement of basic health insurance system between China and Canada is the one of the root system factors which caused the different performance of doctor-patient relationship between two countries.These different arrangements are mainly the financing mechanism,the payment mechanism,the reimbursement mechanism,fund operation and management mechanism,legislative supervision mechanism and the portability.Conclusion A singular focus on doctor-patient inter-personal interactions will not offer a successful solution to the discordant doctor-patient relationship,unless putting the basic health insurance as one of the key factors.International experience shows that good system design can provide good system environment for the doctor-patient relationship.