数字治理推动医保经办增能:应用逻辑与实现路径  

Digital governance promotes the empowerment of medical insurance management: Application logic and implementation path

作　　者：宋娟[1] 仇雨临[2] SONG Juan;QIU Yu-lin(The Inner Mongolia University,Institute of Public Administration,Hohhot Inner Mongolia 010070,China;School of Labor and Human Resources,Beijing 100872,China)

机构地区：[1]内蒙古大学公共管理学院,内蒙古呼和浩特010070 [2]中国人民大学劳动人事学院,北京100872

出　　处：《中国卫生政策研究》2021年第9期20-24,共5页Chinese Journal of Health Policy

基　　金：国家社科基金重点项目(20AZD076);内蒙古社科规划项目(2020NDB071)。

摘　　要：数字治理推动医保经办增能,其应用逻辑是以需求导向为应用理念,以履行第三方购买机制为重点应用场域,以多主体无边界数字治理平台为应用基础,以权力运行机制变革为应用支撑。实现路径是从循证决策走向"循数决策";从行政管制式经办走向契约式治理;从粗放式基金管理走向精细化;从人工监管走向智能算法监管以及从人力密集型组织建设向技术密集型转变。Digital governance promotes the empowerment of medical insurance handling, and its application logic is based on demand orientation, focusing on the implementation of third-party purchase mechanism, taking multi-agent borderless digital governance platform as the application foundation, and taking the reform of power operation mechanism as the application support. The realization path is from evidence-based decision-making to "number-based decision-making", from administrative control to contractual governance, from extensive fund management to refinement, from manual supervision to intelligent algorithm supervision and from manpower-intensive organization construction to technology-intensive.

关 键 词：数字治理 医保经办增能 应用逻辑 实现路径 

分 类 号：R197[医药卫生—卫生事业管理]