新医改区域模式与实施路径设计——以广东湛江为例  

The Regional Pattern for New Medical Reform and the Design of Implementation Path:A Case of Zhanjiang,Guangdong Province

作　　者：季六祥[1] 

机构地区：[1]肇庆学院经济与管理学院,广东肇庆526061

出　　处：《中国软科学》2012年第9期55-71,共17页China Soft Science

基　　金：广东省哲学社会科学基金项目(编号:GD11CGL10)

摘　　要：新医改作为一项实践性课题,是以区域创新来驱动医疗医保体制机制和管理与服务创新,通过区域实践来寻求改革的可行路径,同时依据区域特点和改革目标来作出其个性化的模式选择。"湛江模式"的实质是,引入社保基金增值业务托管或增值再保险方式,建立微利型专业健康险增值代理制,继而尝试构建公共医疗医保协同增值服务体系,核心是实现城乡一体化的健康保障普惠模式。基于实证,本文揭示并分析了包括区域制度创新、协同增值服务、协调商业核查、社区健康管理和社会公益评价等五因素构成的新医改关键成功因素链,以及通过相关概念系规划和多主体构建,勾勒了一个实施路线图,即新医改的"八步走"方案。New medical reform is a practical project, is based on regional innovation to guide the management and service innovation of medical system, with regional practice to explore the path of medical reform, then to find the individuation reform mode based on regional characteristics and reform goal. The essence of ＂Zhanjiang mode＂ is in order to set up micro profit professional health insurance agency system by introducing social security fund value - added custody or value - added reinsurance. It tries to establish public medical and health care collaborative value - added s,ervice system, finally to realize the universal health insurance of integration of urban and rural areas. Based on the empirical evi- dence, we have found the key success factors of new medical reform, include regional system innovation, collaborative value- added services, coordination commercial check, community health management and social welfare evaluation. By the related concept planning and construction of muhiagent, we further describe the implementation roadmap, in other words, it can be considered as an ＂eight steps＂ scheme of new medical reform.

关 键 词：新医改 “湛江模式” 专业健康险 增值再保险 关键成功因素链 

分 类 号：R197.1[医药卫生—卫生事业管理]