医保基金省级统筹:多级治理视角  

Provincial-level Pooling of Medical Insurance Funds:A Multi-Level Governance Perspective

作　　者：吴少龙[1] 张国英[2] Wu Shaolong;Zhang Guoying(School of Government,Sun Yat-sen University,Guangzhou 510275;School of Politics and Public Administration,South China Normal University,Guangzhou 510006)

机构地区：[1]中山大学政治与公共事务管理学院,广州510275 [2]华南师范大学政治与公共管理学院,广州510006

出　　处：《甘肃行政学院学报》2023年第6期4-15,124,共13页Journal of Gansu Administration Institute

摘　　要：提升医保基金统筹层次是实现共同富裕的有效途径,但面临国家建设中最基本的多级治理问题。为什么各地医保统筹在类型、时间、基金、经办方面出现了多元化的模式?本文通过建立一个国家建设和政府多级治理的理论框架来分析医保省级统筹问题,分析再分配功能、医保收入来源和结构、权力利益调整对于医保基金省级统筹的影响。研究认为,医保统筹已经从第二类治理层面上升到第一类治理层面,省财政统筹中央和省级资金在政府投入中是否占主导地位决定了省级统筹的难易程度,医保收入来源和收入结构决定了统收统支或调剂金模式的选择,权力利益的调整影响了垂直管理或分级管理的选择。本文建议省级统筹要从调剂金模式逐步过渡到统收统支,要针对不同医保资金类型进行分类处置,并加强对基金征收的监管。Raising the pooling level of the medical insurance fund is a potent method for achieving common prosperity,yet it en⁃counters the most basic challenges of multi-level governance in the process of state building.Why do diverse modes of medical in⁃surance pooling emerge across different regions in terms of type,timing,funds,and management?This paper establishes a theoreti⁃cal framework of state building and multi-level government governance to analyze the issue of provincial-level pooling of medical insurance,examining the impact of redistribution function,sources and structure of medical insurance income,and adjustment of power and interests on the provincial pooling of medical insurance funds.The study suggests that medical insurance pooling has moved from the second-level governance to the first-level governance issue.Whether the central and provincial funds take a domi⁃nant position in the government’s input of medical insurance determines the difficulty of provincial pooling.The source and struc⁃ture of medical insurance income determine the choice between a unified revenue and expenditure system or a balancing fund mod⁃el.The adjustment of power and interests affects the choice between vertical management or hierarchical management.This paper recommends that provincial coordination should gradually transition from a balancing fund model to a unified revenue and expendi⁃ture system,classify and deal with different types of medical insurance funds accordingly,and strengthen the supervision of fund collection.

关 键 词：多级治理 省级统筹 支出责任 财政工具 医保基金 

分 类 号：C913.7[经济管理] F812[社会学]