我国医保基金监管领域政策文本研究  

Policy research on medical insurance fund supervision in China from the perspective of policy tools based on the national policy documents from 2016 to 2021

作　　者：张晗 张叶凡 嵇丽红 董志伟 蔡伟芹[1,2] 高倩倩 马桂峰[2,4] 于贞杰 井淇 徐凌忠[4,5] 马安宁 ZHANG Han;ZHANG Yefan;JI Lihong;DONG Zhiwei;CAI Weiqin;GAO Qianqian;MA Guifeng;YU Zhenjie;JING Qi;XU Lingzhong;MA Anning(School of Management,Weifang Medical University,Weifang,Shandong 261053,China;“Healthy Shandong”Collaborative Innovation Center for Forecasting and Managing Major Social Risks,Weifang Medical University,Weifang,Shandong 261053,China;School of Public Health,Weifang Medical University,Weifang,Shandong 261053,China;School of Public Health,Shandong University,Jinan,Shandong 250012,China;Key Laboratory of Health Economics and Policy,National Health Commission(Shandong University),Jinan,Shandong 250012,China)

机构地区：[1]潍坊医学院管理学院,山东潍坊261053 [2]“健康山东”重大社会风险预测与治理协同创新中心,山东潍坊261053 [3]潍坊医学院公共卫生学院,山东潍坊261053 [4]山东大学公共卫生学院,山东济南250012 [5]国家卫生健康委员会卫生经济与政策研究重点实验室(山东大学),山东济南250012

出　　处：《中国农村卫生事业管理》2023年第11期797-803,共7页Chinese Rural Health Service Administration

基　　金：山东省社会科学规划研究重大委托项目(21AWTJ08)。

摘　　要：目的了解2016—2021年我国医保基金监管领域相关政策的整体布局与构成特点,为完善与制定医保基金监管“十四五规划”提供参考。方法基于政策工具视角,构建“政策工具-卫生系统宏观模型-利益相关者”医保基金监管领域三维分析框架。结果政策工具维度总体上呈现“供给型-需求型-环境型”金字塔状特征;卫生系统宏观模型维度,政策工具集中分布在管理系统、组织体系、政治系统与技术系统中;利益相关者维度中,政府政策条目数远多于其他利益相关者。结论政策覆盖面广,政府主要通过加强管理与政治系统建设间接影响或加强医保基金监管能力与水平,但人力系统等部分子系统关注较少,且利益关系有待协调,未有效发挥需求型和供给型政策工具拉动与推动合力;建议促进政策工具类型多元化,优化内部结构,提高内部子模政策工具数量,形成均衡利益格局,提高政策多维度间耦合程度,充分发挥交互作用。Objective To explore the overall layout and composition characteristics of relevant policies in the field of medical insurance fund supervision in China from 2016 to 2021,and to provide reference for improving and formulating the“The Fourteenth Five-Year Plan”of medical insurance fund supervision.Methods Based on the perspective of policy tools,a three-dimensional analysis framework of“Policy Tool-Macroscopic Model of Health System–Stakeholders”was constructed in the field of medical insurance fund supervision.Results The dimensions of policy tools showed pyramidal characteristics of“supply-demand-environment”.In the macro model dimension of health system,policy tools were distributed mainly in administrative system,organizational system,political system and technical system.As for stakeholder dimension,the number of government policy items was far more than that of other stakeholders.Conclusions The policy coverage is wide,and the government mainly indirectly influences or strengthens the capacity and level of medical insurance fund supervision by strengthening the construction of administrative and political systems,but pays less attention to some subsystems such as the human subsystem.The interests of stakeholders are to be coordinated,and the demand-based and supply-based policy tools have not yet effectively play a pulling and promoting role.It is suggested to promote the diversity of policy tools,optimize the internal structure,increase the number of internal sub-model policy tools,form a balanced interest pattern,improve the degree of coupling among policy dimensions,and give full play to the interaction.

关 键 词：医保基金 基金监管 政策分析 

分 类 号：R19[医药卫生—卫生事业管理] G353.1[医药卫生—公共卫生与预防医学]