医疗保险机构

医院与医疗保险机构之间接口系统的优化

The Optimal Design of the Interface System between the Hospital & the Medical Insurance Institution

搏弈分析结果：（1）医疗保险机构与医疗服务机构之间博弈过程中，（P1，P2）是医疗服务机构和医疗保险机构博弈纳什均衡点。

The game analysis results : ( 1 ) ( P1 , P2 ) is the Nash equilibrium of medical service institutions and medical insurance institutions game .

而且，在均衡条件下，医院遵守协议概率P1与医疗保险机构审查成本（Z）负相关，与保险机构进行审查时的成功概率（m）、惩罚强度系数（α）正相关。

And in equilibrium condition , P1 is negative correlation with examination cost ( Z ) of insurance institutions and is positive correlation with the probability of successful examining ( m ), punishment intensity ( a ) .

而良好的声誉则有助于增加彼此的信任，降低促成合作的成本，实现合作（3）患者和医疗保险机构博弈纳什均衡为（P5，P6）。

The reputation is helpful to increase mutual trust , promote cooperation and reduce costs in order to achieve cooperation . ( 3 ) ( P5 , P6 ) is the Nash equilibrium of patients and medical insurance institutions game .

常驻阿拉德西城的全科医生MariaSuciu医生说：“我们从国家医疗保险机构获取的资金非常有限，因此我们无法为办公室配备设备。”

Dr Maria Suciu , a general practitioner based in the western city of Arad , says : " The amount of money we receive from the National Health Insurance House is very small and we cannot equip our office . "

别的，假如你没有其他的事变，扣问下医疗保险机构的包围领域。

Also , check on health insurance coverage , if you don 't have another job lined up .

方案中包括建立公共或政府医疗保险机构选择，但是不是像自由主义者希望的那样。

And it includes a public or government option , but not the one that liberals were hoping for .

医疗保险机构主要作为第三方付费者，对公立医院服务价格的公益性进行监督。

Medical insurance companies , as the third party who pay the bill , should supervise the price for services in public hospitals .

最后，针对医疗保险机构、医疗服务机构和患者行为决策影响因素，提出了改善博弈条件，促使其向合作博弈方向发展的合理建议。

Meanwhile it is negative correlation with punishment intensity ( a ) . Finally , for influencing factors of health insurance institution , medical service institution and patients , it offers some reasonable proposals to improve the game conditions and realize cooperative game .

陕西省医疗保险经办机构服务能力现状分析

The situation analysis of the management and services abilities of health insurance administrative agencies in Shanxi province

医疗保险经办机构管理服务能力影响因素通径分析

The research on the factors influencing management and services abilities of medical insurance agencies using the path analysis model

但是由于新农合政策中涉及了参保人、定点医院、医疗保险经办机构等多方主体，关系错综复杂。

But because the new CMS in rural areas involves insurants , listed hospitals , organization of agency of medical treatment insurance , etc , and the relations among these subjects are complicated .

职工医疗保险中医保机构信息管理系统设计与实现

Design and Implementation of Information Management System for Hospitalization Insurance Management Institution of employee

作为医疗保险定点医疗机构，医保系统与医院系统的接口问题必须得到解决。

As appointed medical institutions , the interface between the system and hospital system must be established .

国家医疗保险制度、医疗机构和药品生产流通体制改革三管齐下，医院经营正在经历前所未有的挑战。

The hospitals were facing unprecedented challenge for reform of medical insurance system , medical institution and pharmaceutical producing circulation system carrying out together .

本文运用博弈论方法，对医疗保险制度中医疗机构、参保人、医疗保险机构之间存在的道德风险博弈条件、博弈过程进行了分析，揭示了医疗保险道德风险存在条件、原因以及必然性。

This article uses the gaming theory to analyze the conditions and processes of the gaming between the hospital insured and the Urban Workers ' Basic Medical Insurance organization and revealed the causes and existent necessity of the moral hazard .

本文通过分析城镇职工基本医疗保险制度、医疗机构和药品生产流通体制三项改革实施的背景、目的、内容，阐明改革的必然性和重要性；

In this thesis it analyses the background , purpose and content of carrying out Three Basic Reforms & basic medical insurance system of town staff and workers , medical establishment and the system of medicines ' production and circulation , and illustrates its inevitability and significance ;

同时社区结直肠癌中医慢病管理信息系统可以和医疗管理部门、医疗保险机构、肿瘤登记机构链接，为肿瘤防治政策制定、医疗资源合理分配、诊疗绩效分析提供数据支持。

At the same time the community colorectal cancer TCM for chronic disease management information system link with the medical management departments , medical insurance agencies , cancer registration agency , to provide data support for diagnosis and treatment performance analysis , the rational allocation of medical resources .

进而通过对医疗服务供需双方与医疗保险机构的博弈分析找出其博弈概率的影响因素，提出控制这些因素的大小的措施，以达到抑制道德风险的目的。

And then through the game analysis of both sides of medical services and medical insurance agencies , this paper find the factors that affect the probability of Game . It put forwards measures that control these factors to achieve the purpose of inhibiting moral hazard .

结论建立的病例组合方案及其各组费用标准参考值有利于客观评价该地区医疗产出，为建立该地区政府或医疗保险机构对医院的偿付标准提供了依据。

Conclusion Case mix scheme and charge reference standard per group are helpful to evaluate hospital outcome objectively and provide statistical reference for government and insurance organization .

物流式定点药店的提出，可以将医疗保险领域参保群体药品使用收归到医疗保险承保机构。

The application of the logistic pharmacy concept can put medicine use of the insured of health insurance plans un-der the scrutiny of insurers .

它对医疗服务市场的冲击和影响体现在：社会医疗保险机构制定适合市场经济发展的医疗保险制度来发展和规范医疗服务市场，同时加强监督力度和进行定期考核；

Social insurance institutions formulate medical insurance systems that adapts to development of market economy to develop and standard medical service market . They also strengthen supervision and conduct periodic assessment .

医疗保险结算模式多种多样，不同的医疗保险结算模式对医疗保险机构、医疗服务供方和需求方的影响各不相同。

Many models of medical insurance billing , medical insurance settlement for different medical insurance institutions , medical services , supply-side and demand-side effects are different .

社会医疗保险基金是国家为保障职工的基本医疗，由医疗保险经办机构按国家有关规定，向单位和个人筹集用于职工基本医疗保险的专项基金。

The purpose of the national social health insurance fund is to protect workers basic health care , and it is the special fund raised from units and individuals by health insurance agencies according to state regulations .

通过用人单位和个人缴费，建立医疗保险基金，参保人员患病就诊发生医疗费用后，由医疗保险机构给予一定的经济补偿。

Pass unit of choose and employ persons and individual pay cost , establish fund of medical treatment insurance , ginseng protect personnel sicken to see a doctor after producing medical treatment cost , offer certain economy compensation by medical treatment insurance device .

本文结合我市医疗保险中心医疗保险微机信息管理系统建设实践，对市级医疗保险管理机构微机信息管理系统开发平台的选择进行探讨。

This paper introduces the selection of MIS development platform for city medicare management department , which is based on the medicare MIS development practice of our city .

商业医疗保险：政府积极引导商业医疗保险，鼓励居民参加商业医疗保险；与健康管理机构和社会医疗保险机构相结合，充分发挥其功能。

The government should actively guide the commercial health insurance to encourage residents to participate in it ; and commercial health insurance authorities should combine with health management institutions and social health insurance institutions in order to fully play its function . ( 4 ) Personal expense .

建立和完善我国农村医疗保障制度的立法研究医疗保险的出现，使传统的卫生服务市场中的双边交易关系变成了医疗服务机构医疗保险机构患者的三方交易关系。

Legislative Study on the Establishment and Perfection of China 's Countryside Medical Service Security System Then it analyses the characteristics of medical service and supply and the relationship between patients and supplier .

寻求既能保证医疗高新技术的发展，并持续改进医疗质量、提高工作效率，又能控制医疗成本降低医疗费用的途径，成为各级医疗机构和医疗保险机构的共同目标。

Different medical institutions and health insurance organizations aim jointly at seeking an approach which can insure the advanced medical technology to develop , continually improve the quality of medicine , increase the work efficiency and control the overall costs of medical care in order to decrease it .