医疗保障待遇清单实施中的风险识别及应对策略  

Risk Identification and Corresponding Strategies in the Implementation of the Medical Insurance Benefits List

作　　者：贡森 单大圣[2] 何文炯[1] 

机构地区：[1]浙江大学,杭州310058 [2]国务院发展研究中心,北京100010

出　　处：《中国医疗保险》2024年第1期5-14,共10页China Health Insurance

基　　金：国家医疗保障局课题“完善医疗保障待遇清单管理机制研究”(2023KTYJ3S071)。

摘　　要：精准识别医保待遇清单制度实施中的风险并进行有效管控,是确保医保待遇清单制度平稳顺利实施并有效发挥作用的关键环节。研究发现,医保待遇清单制度涉及的4项政策调整具有高风险,11项政策调整具有中度风险。导致风险形成的因素包括:利益损失、决策不科学不公正、执行偏差、政策缝隙、风险感知差异、改革时机等。建议各统筹地区在落实医保待遇清单制度过程中,注意主动防范风险,完善风险承担机制,加强科学民主决策,加强政策沟通,完善激励约束机制,加快医保事业发展,深化医保综合改革。Accurately identifying and effectively managing the risks involved in the implementation of the medical insurance benefits list system is a key component in ensuring its smooth and successful implementation and effectiveness.The study finds that among the policy adjustments involved in the medical insurance benefits list system,four are high-risk and eleven are moderate-risk.Factors contributing to these risks include loss of interests,unscientific and unjust decision-making,implementation deviations,policy gaps,differences in risk perception,and timing of reforms.It is recommended that each coordinating region,in the process of implementing the medical insurance benefits list system,should focus on actively preventing risks,improving the risk-bearing mechanism,strengthening scientific and democratic decision-making,enhancing policy communication,perfecting incentive and restraint mechanisms,accelerating the development of medical insurance,and deepening comprehensive medical insurance reform.

关 键 词：医疗保障待遇清单 医保待遇支付 风险识别 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]