改革开放以来的社会医疗保险制度改革:政策范式转移与制度约束  

Social Health Insurance Reform since China's Reform and Opening-up: Policy Paradigm Shift and Institutional Constraints

作　　者：彭宅文[1] Peng Zhaiwen(School of Government,Sun Yat-Sen University,Guangzhou 510275,China)

机构地区：[1]中山大学中国公共管理研究中心、政治与公共事务管理学院

出　　处：《社会保障评论》2018年第4期56-74,共19页Chinese Social Security Review

基　　金：教育部人文社会科学重点研究基地重大项目“公务员养老金制度比较研究”(14JJD630004);教育部人文社会科学重点研究基地重大项目“社会政策创新与共享发展”(16J D630011);国家社会科学基金重大项目“中国特色现代社会福利制度框架设计研究”(15ZDA050)

摘　　要：医疗卫生体系转型与绩效提升对健康中国建设具有重要意义。为更好地解释改革开放以来我国医疗卫生体系转型改革中,财政投入增长迅速、政策创新经验突出,而医疗费用风险保护水平改善有限的现象,本文在医疗卫生体系政策分析框架下,审视改革开放40年来社会医疗保险制度改革所经历的政策范式转移。2003年以来,我国医疗卫生体系的目标由为经济政策与经济增长服务转向提高患者医疗费用风险保护水平,这意味着医疗卫生体系的政策范式转移开始启动。在由国家医疗卫生体系模式向社会医疗保险体系模式转型的过程中,地方政府竞争与部门利益及绩效竞争约束了政策目标和管制机制在政策执行中的转变。Healthcare system transformation and performance improvement are of great significance to the implementation of the Healthy China strategy.Since China's reform and opening-up,the growing fiscal input and policy innovations have been accompanied by the lack of financial risk protection.From the perspective of comparative healthcare systems,this paper aims to examine the process of policy change,identify the key policy paradigm shift,and finally to provide an interpretation of the above-mentioned policy phenomena.The healthcare system reform since 2003 began to depart from the approach of developmental social policy by achieving universal health coverage and launching the New Healthcare Reform,triggering a policy paradigm shift from national health services to social health insurance system.In this process,local government competition and fragmented healthcare administration structure constitute institutional constraints on policy implementation.

关 键 词：医疗卫生体系 政策范式转移 社会医疗保险体系 制度约束 

分 类 号：R197.1[医药卫生—卫生事业管理] F842.684[医药卫生—公共卫生与预防医学]