医保支付方式改革并不是一帆风顺
卫生服务提供方管理薄弱：各类保险机构对卫生服务供应方的管理十分不足，服务提供方利用其信息优势自行或与患者合谋侵害医疗保险的成本很低，道德风险严重。
医疗费用不断上涨：城镇医疗保险体系中市场的引入，在很大程度上只是将风险从社会保险转移到商业保险市场中，从而使得商业医疗保险市场延续了社会医疗保险制度的低效性率。致使保险体系的资金平衡面临与日俱增的压力，医疗成本的快速增长，也促使医疗费用不断上涨。
CHALLENGES OF PAYMENT REFORM IN CHINA’S MEDICAL INSURANCE
Weak management on health service providers: The health service providerstake advantage of related information, thus actively or together with patients to defraud medical insurance and lead to moral hazard.
Raising medical costs:The introduction of market in urban medical insurance system largely transfers risk from social insurance to commercial insurance, and keep the low efficiency. The medical insurancefund is faced with increasing pressure, and the rapid growth of medical costs has also promoted the increase of medical costs, and the rapid growth of medical costs has also promoted the medical costs. |
保险公司如何抓住支付方式改革的机遇？
在各种政策的支持下，目前，各大商业保险公司都在布局经办医保的相关试点工作。降低运行成本，提升管理效率和服务质量是商业保险入局基本医保的主要目的。而医疗保险支付方式是医疗保险体制改革的重点与难点，也是医保控费的关键。对于商业保险公司来说，按病种付费的全面推开为2018年的发力奠定了基础。在目前所有支付方式中，DRGs的支付标准相对来说更加科学、合理，不仅可以较好地保障患者的利益，也可有效遏制医疗费用的过度增长。
HOW CAN INSURANCE INSUERS SEIZE THE OPPORTUNITY?
With the support of various policies, major commercial insurance companies, at present, are laying outrelevant pilot work on medical insurance. Commercial insurers aim at reducing the operating cost and improve the management efficiency and service qualityby entering the basic medical insurance market. The payment method of medical insurance is the key and difficulty in medical insurance reform, and is also important to medical cost control. For commercial insurers, DRGs will achieve great development accompanying with many problems. DRGs are relatively scientific and reasonable by protecting the interests of patient and curbing the excessive growth of medical expenses. |
更多关于支付方式改革的话题，欢迎来到我们的大会现场与同行共同探讨！
2018年第二届中国健康保险业创新国际峰会（6月28-29日I上海）
For more information of Payment Reform, we warmly welcome you to attend the 2nd Health Insurance Innovation Congress China 2018 (June 28-29th I Shanghai, China), discussing more about Payment Reform for commercial insurers.
话题：支付方式改革对商业保险公司的机遇和挑战
Topic: The Opportunities and Challenges of Payment Reform for Commercial Insurers |
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2018年第二届中国健康保险业创新国际峰会确认演讲嘉宾
HIIC 2018Confirmed Speaker
邵晓军
健养中心首席医务官，太平洋人寿保险股份有限公司
Steven Shao
Chief Medical Officer, Healthcare Division,
China Pacific Life Insurance Co., Ltd.
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