北京航空航天大学学报社科版 ›› 2021, Vol. 34 ›› Issue (1): 69-75.DOI: 10.13766/j.bhsk.1008-2204.2020.0517

• 公共政策与治理 • 上一篇    下一篇

医保待遇调整与支付改革协同治理研究

翟绍果, 陈兴怡   

  1. 西北大学 公共管理学院, 陕西 西安 710127
  • 收稿日期:2020-11-05 发布日期:2021-02-02
  • 作者简介:翟绍果(1980-),男,河南邓州人,教授,博士,研究方向为医疗保险与健康保障.
  • 基金资助:
    国家社会科学基金(18BSH047)

Collaboration of Health Security Benefits Adjustment and Payment Method Reform

ZHAI Shaoguo, CHEN Xingyi   

  1. School of Public Administration, Northwest University, Xi'an Shaanxi 710127, China
  • Received:2020-11-05 Published:2021-02-02

摘要: 新时期中国医保制度进入高质量发展阶段,医保待遇调整与支付既具有全民参保的基础和改革深化的机遇,也面临刚性增长压力和复杂的社会挑战,这不仅要求医保待遇的动态调整与支付制度的复合式改革,更需要两者的协同联动。因此,应当将重构均衡作为深化医保改革的重要任务。在目前待遇水平稳步提高、政策规范更加统一和支付改革持续推进的现状下,应理性看待当前医保在公平性、可持续性、支付效果、保障效应等方面的实际问题,通过制度整合、管理磨合、运行耦合、资源聚合、治理融合等机制促进医保待遇与支付协同治理。

关键词: 医疗保障, 高质量发展, 医保待遇调整, 医保支付, 协同治理

Abstract: In the new period, the Chinese health security system has entered a stage of high-quality development. The benefits adjustment and payment of medical security not only have the foundation of universal participation and the opportunity of deepening reform, but also face the pressure of rigid growth and complex social challenges. However, the rigid growth pressure of welfare and rapid social changes pose challenges, which requires not only the dynamic adjustment of health insurance benefits and the compound reform of the payment system, but also the coordination of these two elements. Therefore, it's necessary to regard the reconstruction of equilibrium as an important task in deepening the health insurance reform. Additionally, the systems face such status and problems as gradual increasing but unequal benefits, large balances but unbalanced structure fund, advancing but improper linkage payment reform. Due to this, the deepening development of the health secarity system need the integration of institution, management, operation, resource, and governance.

Key words: health care, high-quality development, health secarity benefits adjustment, reform of payment method, collaboration

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