关于医疗保险支付方式的论文

中国循证医学杂志 2009, 9(11): 1193～1199

论 著 二次研究

中美两国医疗费用控制理论与方法比较研究

郑小华1 胡锦梁1 钱恩奎1 翟清华2 蒋 超2

1. 四川省医学科学院（四川省人民医院）卫生政策与信息技术研究所（成都 610072）；2. 成都中医药大学管理学院（成都 610075）

摘要 目的 医疗费用增长是一个国际性问题，通过比较中美医疗费用控制的理论和方法，寻找出适应于我国医疗费用控制的策略，服务于我国正在进行的新一轮医疗卫生体制改革。方法 根据检索策略搜索文献，而后按照纳入排除标准筛选文献，并用文献定量分类表提取相关信息进行描述性统计分析。结果 在对医疗费用的控制问题上，美国学术界呈现出持续、稳步增高的关注趋势，而中国学术界则显示出较大的波动性；在对医疗费用增长原因、医疗费用增长的合理性以及所主张的医疗费用控制的具体方法和策略上，中美两国学者存在较大差异。结论 医疗费用控制目的源于不同的发展基础，而且利益主体确定医疗费用控制主体。我国应因地制宜的开发有效的费用控制策略与方法。

关键词 医疗费用；费用增长；费用控制；比较研究

A Comparative Study on Theories and Methods of Medical Expenditure Control between China and the US

ZHENG Xiao-hua1, HU Jin-liang1, QIAN En-kui1, ZHAI Qin-hua2, JIANG Chao2

1. Health Policy and Information Technology Institute in Sichuan Medical Academy and Sichuan Provincial People’s Hospital, Chengdu 610072, China 2. School of Management in Chengdu University of TCM, Chengdu 610075, China

Abstract Objective The rising medical expenditure is an international problem. By comparing theories and methods of medical expenditure control between China and the US, this paper aims to nd out the medical expenditure strategies tting for our country and to help with the new round of medical and health system reform. Methods This evidence-based research searched for literatures using the search strategy and screened literatures according to inclusion and excluding criteria. Useful information in the literatures was extracted through quantitative analysis of literature tables and descriptive statistical analysis. Results We found that the US academia showed a sustainable and steady trend of increased concern on the medical expenditure control, while the Chinese academia showed a larger volatility on it. There were some obvious differences such as reasons for expenditure increase, the reasonableness of the medical expenditure increase, and the specific methods and strategies of the medical expenditure control between Chinese and American authors. Conclusion On the one hand, the purpose of medical expenditure control is based on the different stages of development. On the other hand, the main interest group determines the main body who is responsible for the medical expenditure control. According to our national context, China should develop effective strategies and methods for medical expenditure control.

Key words Medical expenditure; Expenditure increase; Expenditure control; Comparative study

医疗费用过快增长是一个国际性问题，各国卫生经济学界、政府卫生主管部门、医疗保险举办者、医院管理者、国家财政部门都高度关注本国医疗费用的上涨，并采取各种措施，力图将医疗费用控制在本国居民或国家财力所能承受的范围之内。然而，对于如何控制医疗费用（即采取什么样的控制策略和方法），医疗费用控制的目标和基础是什么，不同

的国家和地区不尽相同。迄今为止，没有一个国家宣称自己的医疗费用控制取得了成功，也没有一个学者宣称自己已经解决了医疗费用控制理论和方法问题。

学习西方是近20年来国内卫生经济学界的主要策略，前十年是翻译期，西方经济学的理论和方法被引入国内，呈现于教科书，无数的新理论和新方法在学界流传，在象牙塔中轮转，直到1998年，我国医疗体制基本没有发生实质性的改变。后十年是实践期，我们开始用市场经济的眼光来审视中

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作者简介：郑小华，男（1956年～），硕士，教授，主要研究方向：卫生经济与卫生管理决策。

© 2009 中国循证医学杂志编辑部