【摘要】 促进超大城市多层次医疗保障体系的有序衔接，是推进国家医疗保障治理能力现代化的重要探索。以典型超大城市上海为案例，基于复杂适应系统理论，评估多层次医疗保障体系的发展现状与衔接困境，探索衔接机理并提出应对策略。研究发现，上海市多层次医疗保障体系存在系统结构复杂和职责分工混乱，报销流程无序和待遇标准不一，衔接方式分立和路径依赖明显等衔接困境，可通过建构补充层资源补偿、全系统有序重组、关系学习优化三个衔接机制，探索强化不同制度与治理主体的整合协同、实现信息共享及保障待遇的接续给付、优化保障内容与医疗服务利用的衔接路径。上海市多层次医疗保障体系的衔接运行机理提供了一种将整体系统内部结构的静态阐释与动态演进相结合的思路，对理解乃至形塑我国可持续、高质量发展的医疗保障系统具有借鉴意义。更多还原

【Abstract】 Promoting the connection of the multi-tiered medical insurance system in mega-cities is an important exploration to promote the modernization of the country’s medical insurance governance capacity. This paper takes Shanghai, a typical mega-city, as a case study. Based on the theory of complex adaptive systems, it evaluates the status and dilemma of the multi-tiered medical insurance system’s connection, explores the connection mechanism, and proposes strategies to cope with it. It was found that the connection of multi-tiered medical insurance system in Shanghai has problems such as complex system structure, confusing division of responsibilities, disorganized reimbursement process, inconsistent treatment standards, separation of connection modes and path dependency. Through supplementarylevel resource compensation, system-wide reorganization and relationship learning optimization, we can explore ways to strengthen the integration and synergy of different systems and governance bodies, achieve information sharing and successive payment of benefits, and optimize the content of protection and the use of medical services. The connection and operation mechanism of Shanghai’s multi-tiered medical insurance system provides a way of thinking that combines the static interpretation of the internal structure of the overall system with its dynamic evolution, which is useful for understanding and even shaping China’s sustainable, high-quality development of the medical insurance system.更多还原