我国城镇医疗费用供方制约机制探究关于深化城镇医疗保险制度改革

上海交通大学硕士学位论文我国城镇医疗费用供方制约机制探究--关于深化城镇医疗保险制度改革的思考姓名：史文璧申请学位级别：硕士专业：金融学指导教师：黄丞200501011998ThereformofChineseurbanhealthinsurancesystemenforcedfrom1998hasnowachievedgreateffects.Themostimportantproblemencountered,however,isthefastincreasingtrendofhealthexpenditures,whichismainlyduetohealthproviders’improperbehaviors.ThemainobjectofthisthesisistofindoutasetofpracticalandeffectivesuppliercontainmentmechanisminordertohelpChineseurbanhealthinsurancesystemhaveacontinuousdevelopment.Thenamed“supplier”inthephrase“suppliercontainmentmechanism”meanstheproviderofhealthservices,ie.hospitalsanddoctors.Healthserviceprovidersusuallystimulatehealthexpendituresintwowaysthroughsocalled“supplier-induceddemand”andstimulatinghighpricingofmedicine,bothofwhichresultfromtheproviders’marketmonopolisticpower.Uptonow,Chinesegovernmenthasmadegreateffortstotrymanydifferentwaystocontainsuppliers’behavior,includinghealthinsurancereformsandsomeotherpoliciesfocusingonhealthmanagementandmedicinemarket.Theseattempts,however,cannotachieveobviousorlong-termeffectsbecausetheyneverdestroythesuppliers’monopolisticpower.Managedcare,akindofeffectiveandfastgrowinghealthinsuranceplan,hasbeenpaidgreatattentiontobymoreandmorecountriesinthepastfewyears.Thethesismadeathroughintroductiontothisnewform,includingitscharacters,organizationformsandespeciallyitsexpenditurecontrollingmethods,hopingtofindimplicationsforournewsuppliercontainmentmechanism.Finally,basedontheseaboveresearches,theauthordesignedabrand-newsuppliercontainmentmechanismforChineseurbanhealthinsurancesystemmakingfulluseoffourseparatemechanisms,whichwillhelptheinsurancesystemachieveacontinuousdevelopment.Moreover,asetofrelatedmethodsarealsoprovidedtohelpgainidealeffectsasexpected,whichincludesmakingimprovementonthequalityofcommunityhealthservices,speedinguphealthinformationsystemconstruction,promptingreformsonhealthindustrialmanagementsystem,andetc.HealthInsurance,HealthExpenditure,Supplier-InducedDemand,HighPricingofMedicine,ManagedCare,SupplierContainmentMechanism11.1100MedicareMedicaid1.21.2.12199419944141994111819951996571.2.21998123126%2%330%70%410%41-11-141.2.3199812341990200218%GDP15%13%199810%GDP1998-20027.5%1.3GDP19504.5%19605.1%13-14%[2]1960198720-25%14%17%[3]199930.1GDP7.9%[4]51993200117800[5]9020019983000[6]1.3.1201-119801432002568540198020029%199526%2218.2%GDP1980GDP15%20025.42%1-11980-2002198019901995199719981999200020012002143.2747.42155.13384.93776.54178.64586.65025.95684.6(%)18.926.311.610.69.89.613.1GDP%3.174.033.694.554.825.095.135.165.4214.565.4177.9273.8302.6331.9361.9393.8442.6200120041-21990-2003199019951996199719981999200020012002200310.939.952.561.668.879.085.899.6108.2(%)31.617.311.714.88.68.647316682190238425972891308435983911(%)31.38.98.911.36.78.7199719992004620042002659652923022090114732003108.23910.78.97.31-21990-20031GDP1978362420021047919.4%1978113220021890312.4%20027703199061937.7%1.13[7]26019807.6%200010.2%654.9%7%[11]54%25%[12]80646-8[13]319851002002270.9330.6475.14520906771.3.219741982RandHealthInsuranceExperimentHIE151527567708[14]812HMO91.41-2102.12.1.11234[15]1152.1.22.1.3122.1.4Supplier-inducedDemandSIDSIDMaxShainMiltonRoemer1960[17]2-1SIDD1S1Q1P1S2P1P3Q1Q3SIDD113D2P2Q2D’2P’2Q’2PD’2S1D2S2D1P’2P1P2P30Q1Q3Q2Q’2Q2-1SID2-1SIDSID2.1.5199069.6%199750%56%72%[19]198011995150[20]918050[21]30%-40%50%90%[22]142.22.2.127.53846.7583244.858[23]2626.556[24]2001916.71241.1011.520.70180.3011.70200283116500045%[28]2-215/152040801001152-2152040408040408010015%115100120011014122051712017050C142.5150%50109.5162.2.2120006,30016,000120,000[30]97%22.2.3180%17273%199638%199780%50%70%19979369[31]3182.2.4193.119943.1.11995111995-19962020%20%20%1992-199433.4%19955.2%28.2199636%21997-199831999-20001995-1998199814445132657619991052.60583.26469.34200025%1996214200130%60%20003-11995-20022.5%36%7%13%3.5%25%8.3%7%0%10%20%30%40%199519961997199819992000200120022219953.1.220001211994119947-2001100%X50-100%CT12-25%GDP1994199820003-13-11994-2000GDP1994199519961997199819992000%2423191515117%151515121295GDP%30.524.917.915.89.89.412.8200123199423%1994199355.1%1992-199340%-70%19993-23-21992-1999[36]19906.01%199918.8%54%44%199363.5%199950.7%200019932.672000242200220047.5%20046%70%73.1.3253.23.2.119991226343-51516720035123.2.22720033.33.3.120901997199920007123283.3.25080903.43.4.120002200072920022-360%3.4.280%20012002000107[44]30314.1ManagedCare20607019961.112344-1324-1[17]4.21HealthMaintenanceOrganizationHMOHMOHMOHMOHMOHMOHMOHMOHMOHMO2PreferredProviderOrganizationsPPOPPO33PPOPPOPPOPPOPPOPPOPPO3Point-of-servicePOSHMOPPOPPOPOSPOSHMOPOS1993POS199520%4-14-1PPOPOSHMO4.3134X2HMO20%HMOPOSPPO3HMOPPO43554.41234536610%-40%30%375.112345385-15.212343915%405.35.3.11999820037-8[59]415.3.212345425.3.37JCAHOACHSCBO5.3.44380%GMPGMP5.3.5445.3.612455.3.746[1]1998441998[2]2002170-82[3][]1996[4]2001660-61[5]1999139-40[6]19983[7]Schieber,C.,Maeda,A.,ACurmudgeon’sGuidetoFinancingHealthCareinDevelopingCountries,WorldBankDiscussingPaperNo:365,1997[8]20032003[9][10][]2003[11]2002325-27[12]19995287-289[1