国外医疗保险的规制治理及对我国的启示  

Regulation and governance of the foreign medical insurance and its enlightenment for China

作　　者：楼依玲 徐鸿彬 卢祖洵[1] 曹世义[1] LOU Yiling;XU Hongbin;LU Zuxun;CAO Shiyi(School of Public Health,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430030,China)

机构地区：[1]华中科技大学同济医学院公共卫生学院,湖北武汉430030

出　　处：《中国农村卫生事业管理》2024年第2期83-88,共6页Chinese Rural Health Service Administration

基　　金：国家社会科学基金重大项目(18ZDA085);华中科技大学中央高校基本科研业务费专项资金(2020WKZDJC015)。

摘　　要：随着社会经济不断发展和医疗体制改革持续深化,我国医保场域发生巨大改变,治理失序现象频发。文章通过系统总结我国医保规制治理中医保法治建设滞后、规制主体职责不清、医保规制工具单一等现实困境,借鉴英国、美国、德国、荷兰等国家医保规制与治理行动中法律、体系、制度与技术手段等层面的经验,提出优化医保法治环境、明确规制责任主体、综合运用规制工具等路径建议,以此疏通医保规制治理的阻滞环节,提升医保运行安全性与治理效力。With the continuous development of social economy and the deepening of health system reform,great changes have taken place in the medical insurance field in China,and the disorder of management occurs frequently.Based on a systematic summary of the dilemma of medical insurance regulation and governance in China,such as lagging legal construction of medical insurance,unclear regulatory responsibilities,and single regulatory tools of medical insurance,this study learned from the experience in law,framework,system and technical means of medical insurance regulation and governance action in typical countries such as UK,USA,Germany and Holland,and put forward some path advice,including optimizing the legal environment of medical insurance,clarifying the main body of regulatory responsibility,and comprehensively applying regulatory tools,so as to dredge the blocking link in the anti-fraud management of medical insurance,and improve the operation safety and governance efficiency of medical insurance.

关 键 词：医疗保险 体制改革 规制 治理 国际经验 启示 

分 类 号：R19[医药卫生—卫生事业管理] R199[医药卫生—公共卫生与预防医学]