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国际上越来越多的健康保险(医疗保险)采用了管理医疗的方式,目的在于保证健康服务质量并节约成本。尽管该方式在控制成本方面的效果有目共睹,但对于其保证健康服务质量方面的评价则颇为困难。本文使用独特的大样本数据,利用美国加利福尼亚州医疗救助项目(美国最大的公共健康保险之一)从传统按次偿付方式到多种管理医疗模式的转变,来识别不同管理医疗模式对健康服务的使用及服务质量的影响。这对于我国公共健康保险制度(如新型农村合作医疗)的探讨具有一定的借鉴意义。
More and more international health insurance (health insurance) has adopted the way of managing medical treatment in order to guarantee the health service quality and save the cost. Although the effectiveness of this approach in controlling costs is evident, it is difficult to evaluate its quality of health services. Using a unique large sample of data, this article uses the transition from traditional pay-as-you-go programs to a variety of managed medical models using the California State Medicaid, one of the largest public health insurance programs in the United States, to identify patterns of health care delivery for different managed healthcare models Use and quality of service impact. This is of some reference to the discussion of China’s public health insurance system (such as new rural cooperative medical care).