浙江省基本医疗保险支付制度改革的政策演进模式研究  

Research on Policy Evolution Model of Payment System Reform of Basic Medical Insurance in Zhejiang Province

作　　者：李宗伟 蔡兰芳 苑荣 李先锋[2] LI Zongwei(School of Economics and Management,Shanghai Institute of Technology,Shanghai,200030,China)

机构地区：[1]上海应用技术大学经济与管理学院,上海200030 [2]上海交通大学医学院附属新华医院长兴分院,上海201913

出　　处：《医学与社会》2023年第1期105-110,共6页Medicine and Society

基　　金：国家自然科学基金资助项目,编号为71974130;上海市浦江人才计划资助项目,编号为2019PJC096。

摘　　要：目的:借助扎根理论,对浙江省基本医疗保险支付制度改革的政策演进模式进行解构,并提出新时期深化改革的策略,为构建现代化高质量的医疗保障体系提供参考。方法:基于1998-2021年浙江省发布的31份医保支付政策文本,对其进行三级编码,构建出政策动态演进的理论模型。结果:依据浙江省医保支付制度改革经历的3个阶段,通过三级编码,最终梳理出与医保支付制度相关的177个概念、33个范畴、13个主范畴和3个核心范畴,整理为契约式管理模式、激励相容管理模式和管理创新模式3条脉络。结论:浙江省持续深化医保支付制度改革进程中,从契约式管理,统一制度规范,到建立激励相容机制,约束医疗双方行为,再到管理创新,保障全民健康。其改革演进模式遵循各阶段下民众切实的医疗保障需求和社会发展的内在规律,进而呈现出不同的改革关注的方向,形成对应的模式。“十四五”期间,应明确以民众健康为中心的改革理念,构建科学合理的支付方式,打造数字化的监管模式,促使医保支付制度更加高效管用,推动医疗保障体系高质量发展。Objective:To deconstruct the policy evolution mode of basic medical insurance payment system reform in Zhejiang province with the help of grounded theory,and put forward the strategy of deepening reform in the new era,so as to provide references for the construction of modern high-quality medical security system.Methods:Based on 31 medical insurance payment policy texts issued by Zhejiang province from 1998 to 2021,a theoretical model of policy dynamic evolution was constructed through three-rank coding.Results:According to three stages of reform of medical insurance payment system in Zhejiang province,177 concepts,33 categories,13 main categories and 3 core categories related to medical insurance payment system were finally sorted out through three-rank coding,which were summarized as three threads including contract management mode,incentive compatible management mode and management innovation mode.Conclusion:Zhejiang province continues to deepen the reform process of medical insurance payment system from contractual management and unified system norms,to the establishment of incentive compatible mechanism in order to constrain the behavior of both sides of the medical treatment,and then to management innovation in order to ensure the health of the whole people.The evolution mode of the reform follows people’s practical medical security demand and the internal laws of social development in each stage,and then presents different directions of reform attention and forms corresponding modes.During the 14th Five-Year Plan period,it is recommended to clarify the reform concept centered on people’s health,establish scientific and reasonable payment methods,create a digital supervision model,make payment system of medical insurance more efficient and effective,and promote high-quality development of the medical security system.

关 键 词：基本医疗保险 医保支付制度 浙江 

分 类 号：R19-0[医药卫生—卫生事业管理]