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我国部分省份基本医保省级统筹的政策内容比较分析与优化

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目的:深入了解我国16个省份在基本医保省级统筹方面的实施模式及实践中存在的问题,为推进省级统筹提供具有参考价值的建议.方法:采取内容分析法对基本医保省级统筹在政策完善、统筹模式、激励约束、赋权与考核、支撑保障等方面的政策工具进行梳理和深入分析.结果:在推进省级统筹的过程中,各省份统一或逐步统一了医保筹资、待遇保障政策,推动与地区实际契合的医保统筹模式;部分省份已构建结余留存和缺口分担的激励约束机制,不仅明晰了省级与市级的权责关系,还建立了绩效考核机制,管理效率与质量得到进一步提升.结论:高效的省级统筹需要通过完善政策、平衡风险、赋权与评估考核、支撑保障等适配工具,实现参与主体间利益的激励相容;各地因地制宜推动与地区实际契合的医保省级统筹模式,但政策工具设计的科学性和有效性有待进一步提高.
Comparative Analysis and Optimization of the Policy Content of Unified Planning for Basic Medical Insurance at the Provincial Level in Some Provinces of China
Objective:The paper attempts to understand the implementation mode and problems of unified planning for basic medical insurance at the provincial level in 16 provinces of China and provide valuable suggestions for promoting provincial unified planning.Methods:Content analysis was used to analyze policy tools of unified planning for basic medical insurance at the provincial level in terms of policy improvement,pooling mode,incentives constraints,empowerment and assessment,and support and guarantee.Results:In the process of implementing unified planning for basic medical insurance at the provincial level,medical insurance financing and benefit guarantee policies have been unified or gradually unified,and medical insurance unified planning mode that were compatible with regional realities have been promoted.Some provinces have established the incentive and constraint mechanism for balance retention and gap sharing,clarified the relationship of power and responsibilities between the provincial level and municipal level,and established the performance appraisal mechanism.Conclusion:Efficient provincial unified planning requires the improvement of policies,risk balancing,empowerment,evaluation and assessment,and other supporting tools,to make incentive compatibility of interests among participating entities.It is suggested to promote the provincial unified planning model that is tailored to local conditions and in line with regional realities,however,the scientificity and effectiveness of the policy tool design needs to be further improved.

unified planning at the provincial levelpolicy toolrisk balancing mechanisms

朱晓丽、王玙珩

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中国医学科学院医学信息研究所 北京 100020

中国医学科学院卫生政策与管理研究中心 北京 100020

省级统筹 政策工具 风险平衡机制

2024

中国医疗保险
中国医疗保险研究会

中国医疗保险

影响因子:0.492
ISSN:1674-3830
年,卷(期):2024.(10)