激勵機制、資源約束與監管成本：醫保經辦機構組織能力影響醫療費用增長的實證研究

新醫改促生了一個“雙增”悖論：醫保快速發展的同時，醫療費用和個人負擔也在快速增長。前人研究關注“技術決定論”，即醫保付費方式改革對費用增長的抑制作用；但鮮有研究關注醫保經辦機構組織能力對醫療費用的影響。論文採用混合研究方法，檢驗醫保經辦機構的激勵機制、資源約束和監管成本與醫療費用增長之間的關系。定性研究基於三個城市的田野調查，發現醫保經辦機構控費能力孱弱的原因在於激勵不足、資源匱乏和監管成本過高。定量研究採用省際面板數據，發現醫保經辦機構激勵不足和行政經費有限導致醫療費用增長。指出，要從根本上抑制醫療費用過快增長，必須加強醫保經辦機構的能力建設、控費激勵和資源投入，完善第三方購買機制。
The newest round of health care reform in China has produced a paradox: while social health insurance coverage has expanded rapidly, healthcare costs and out-of-pocket expenditureshave increasedquickly too. Previous studies focused on the role payment methods played in curbing medical costs, but few investigated the impact of the organizational capabilities of the relevant social health insurance agencies. Employing a mixed-methods design, this study examines the effects of incentive structure, resource constraints, and regulation costs for these insurance agencies as they relate to medical cost inflation. Based on fieldwork in three Chinese cities, the study’s qualitative results attribute the weak role insurance agencies play in cost containment to lack of incentives, insufficient resource input, and high regulation costs. Using panel data analysis, the study’s quantitative findingsshow a lack of incentives and insufficient financial resources lead to medical cost inflation. This paper suggests the government could improve the organizational capabilities of social health insurance agencies and third-party purchasing by reforming their incentive structures and investing financial resources. Copyright © 2018 廣東人民出版社有限公司; 廣東省治理現代化研究所.