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医保系统和医疗系统协同发展探讨:目标、分工与协作

Discussion on the coordinated development of health insurance system and medical system: Target, division and coordination

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【作者】 牛亚冬张亮张翔吴建苗豫东

【Author】 NIU Ya-dong;ZHANG Liang;ZHANG Xiang;WU Jian;MIAO Yu-dong;School of Public Health, Zhengzhou University;School of Public Science and Public Administration, Wuhan University;School of Medicine and Health Management, Huazhong University of Science and Technology;Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education;

【通讯作者】 吴建;

【机构】 郑州大学公共卫生学院武汉大学政治与公共管理学院华中科技大学同济医学院医药卫生管理学院湖北省人文社科重点研究基地农村健康服务研究中心

【摘要】 协同发展是提高医保系统和医疗系统效率的关键,但当前医保系统和医疗系统更多的是孤立式改革和表面上联动。本文从价值角度分析了医保系统和医疗系统协同发展的可行性,从可持续发展角度分析了二者的协同发展目标,即可持续健康,包括提高居民健康水平、构建分级有序服务秩序、控制卫生服务成本三个子目标,并以此为基础梳理了医保系统和医疗系统各自的分工和协作机制,以期为两个系统的协同改革提供借鉴。

【Abstract】 Coordinated development is the key to improving the efficiency of the health insurance system and the medical system, but the current health insurance system and the medical system are more isolated reforms and superficial linkages. This paper analyzes the feasibility of the coordinated development of the health insurance system and the medical system from the perspective of value, and analyzes the synergistic development goals of the two from the perspective of sustainable development, namely sustainable health(including three sub-goals: improving the health level of residents, building a hierarchical and orderly service order, and controlling the cost of health services), and on this basis, the division of responsibility and coordination mechanism between the health insurance system and the medical system are sorted out, in order to provide reference for the collaborative reform of the two systems.

【基金】 国家自然科学基金重点项目(71734003)
  • 【文献出处】 中国卫生政策研究 ,Chinese Journal of Health Policy , 编辑部邮箱 ,2023年10期
  • 【分类号】R197
  • 【下载频次】112
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