医保谈判机制运行障碍因素与对策探讨

摘要

阐释了医保谈判机制的内涵及运行现状,分析并探讨了医保谈判机制运行的障碍因素,主要包括医保机构对谈判的总体协调能力不足、为规避医疗风险医院缺乏控制医保费用的积极性、医保机构对控制费用的期望与医药企业追求利润的预期相矛盾等,提出应推进政府部门之间职能有机统一的体制机制改革、提升医疗机构和医生对风险的承担和化解能力、完善对医疗机构的激励约束机制等对策建议,以促进医保谈判机制的顺利运行与优化.%Introduced in the paper are the connotation and current operations of the medical insurance negotiation mechanism.The authors also discussed obstacles blocking operations of the mechanism, including insufficient coordination capacity of the medical insurance institution over the negotiation, and lack of motivation of the institution for curbing costs and the contradiction against the profit pursuit of drug companies.Corresponding countermeasures and suggestions are put forward in the end, namely system reform for inter-governmental functions, enhancement of the capacity of both medical institutions and doctors against risks, and perfecting the restraint and incentive mechanism for medical institutions, aiming at smooth operation and optimization of the medical insurance negotiation mechanism.