战略性购买视角下的医保基金监管体制改革探讨与展望  

Discussion and Prospect on Medical Insurance Fund Supervision System Reform from the Perspective of Strategic Purchase

作　　者：胡敏 Hu Min(School of Public Health,Fudan University,Shanghai,200032)

机构地区：[1]复旦大学公共卫生学院卫生经济学教研室,上海200032

出　　处：《中国医疗保险》2021年第4期26-30,共5页China Health Insurance

摘　　要：在深化医疗保障制度改革的背景下,医保基金的使用监管应坚持以保证基金战略性购买为发展方向,即监督和引导医药服务供给侧提供更加公平、更高质量和更有效率的服务;以系统性思维理论为基础,让行政监管、协议监管和信用监管在一个复杂、交互、动态的系统中发挥各自特点和作用,协同高效;同时大力发展医保监管科学,助力科学监管,优先开发医保购买及监管结果评价工具,并对不同监管工具的有效性开展实证研究。Under the background of deepening the reform of the healthcare security system,the supervision of the use of medical insurance fund should adhere to the development direction of ensuring the strategic purchase of the fund.In other words,we should supervise and guide the medical service supply side to provide more fair,higher quality and more effi cient services.Based on the theory of systematic thinking,we should let administrative supervision,agreement supervision and credit supervision play their own characteristics and roles in a complex,interactive and dynamic system.At the same time,we should vigorously develop medical insurance supervision science,help scientifi c supervision,give priority to the development of medical insurance purchase and supervision result evaluation tools,and carry out empirical research on the eff ectiveness of diff erent supervision tools.

关 键 词：医疗保障 监管 系统思维 协议管理 监管科学 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]