系统论视角下医院医保"链-网"治理体系的构建

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中文摘要：在老龄化加速、慢性病负担加重的结构性压力下,落实党的二十大报告提出的"促进医保、医疗、医药协同发展和治理"的医药卫生体制改革任务,迫切需要医院构建与"三医"协同适配的医保治理体系.为了打破过去单一化、碎片化、被动式的医保管理方式,依据系统论的理论框架,提出由政策-责任链、信息-流程链、协同-共识链、检查-评价链以及绩效-价值链5"链"构筑的"链-网"医保治理体系,并就其实施路径、必要性与完备性、支撑要素进行分析.

外文标题：The Construction of the"Chain-Net"Governance System of Hospital Medical Insurance under the Per-spective of System Theory

外文摘要：Under the structural pressure of aging acceleration and increased chronic disease burden,in order to implement the reform tasks of"promoting healthcare,insurance and pharmaceutical sectors coordinated develop-ment and governance"proposed by the 20th National Congress of the Communist Party of China,it is urgent to build a medical insurance governance system that is adapted to the"Synergistic goverance on healthcare,insurance and pharmaceutical sectors".In order to break the single,fragmented,and passive medical insurance management methods in the past,according to the theoretical framework of system theory,it proposes the"chain-net"gover-nance system of hospital medical insurance built by the policy responsibility chain,information process chain,col-laborative consensus chain,inspection evaluation chain,and performance value chain,and analyzes,the implemen-tation path,necessity and completeness and support elements of this system.

外文关键词：

the"chain-net"governance system of hospital medical insurancesystem theorysynergistic governance on"healthcare,insurance and pharmaceutical"sectors of modern hospital governance

作者：

梁力中、朱丽云、曾志嵘

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作者单位：

广东医科大学湾区医疗保障与现代医院治理研究院广东湛江 524023

广东医科大学附属医院广东湛江 524023

广西师范大学政治与公共管理学院广西桂林 541006

广东医科大学公共卫生与健康研究院广东东莞 523808

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关键词：

医保"链-网"治理体系系统论现代医院治理"三医"协同

基金：

教育部人文社会科学研究项目

项目编号：

22YJA630004

出版年：

2024

中国医院管理

中国医院管理杂志社

中国医院管理

CSTPCD北大核心

影响因子：2.15

ISSN：1001-5329

年,卷(期)：2024.44(8)