强基层导向下县域医保基金战略性购买的实现路径研究  

Research on the realization path of county health insurance strategic purchasing under the orientation of strengthening the primary health services

作　　者：贺睿博 罗琳彬 邢怡青 李浩淼 张亮[1] HE Rui-bo;LUO Lin-bin;XING Yi-qing;LI Hao-miao;ZHANG Liang(School of Political Science and Public Administration,Wuhan University,Wuhan Hubei 430072,China;Medical Insurance Reform Collaborative Innovation Center,Hubei University of Economics,Wuhan Hubei 430205,China)

机构地区：[1]武汉大学政治与公共管理学院,湖北武汉430072 [2]湖北经济学院医疗保险改革协同创新中心,湖北武汉430205

出　　处：《中国卫生政策研究》2024年第7期1-7,共7页Chinese Journal of Health Policy

基　　金：国家自然科学基金青年项目(72104073)。

摘　　要：医保基金作为医疗机构赖以生存和发展的资源,在县域却呈现出结构性摩擦的发展态势。本研究通过对战略性购买和医保系统功能关系辨析,明确了支付的核心地位,以及基金分配与服务补偿的作用;通过对县域医保基金与基层服务失衡原因的剖析,明确了县域医疗服务的战略性购买需兼顾支付的前端——分配,以及服务的前端——基层。在此基础上,探索性提出了县域基层医保战略性购买,通过改变基金分配方式,以切断医院与基层间基金“竞争”渠道;调整服务补偿方式,以引领基层主动识别并满足县域居民服务需要变化;辅之以“医保+卫健”联动宣讲、协同监管等措施,逐步推动县域基层卫生服务从可持续发展迈入高质量发展。The health insurance fund acts as the resource for the survival of medical institutions.However,it has shown a development trend of structural friction in the county.By analyzing the relationship between strategic purchasing and the function of health insurance system,this study clarifies the central position of payment and the roles of fund allocation and service compensation.By analyzing the reasons of the imbalance between the health insurance fund and primary services in the county,this study proposes that the strategic purchasing of health care services in the county needs to take into account both the front-end of payment-allocation,and the front-end of service--primary.On this basis,this study put forwards the strategic purchasing of primary health services,which aims to cut off the fund“competition”channel between hospitals and primary health care institutions by changing the fund distribution method;to guide the primary health care to proactively identify and satisfy the changes of the county s residents’service needs by adjusting the service compensation method;and supplemented with joint advocacy and collaborative supervision.The strategic purchasing of primary health services will gradually promote the development of primary health services in the county from sustainable to high-quality.

关 键 词：基层卫生 战略性购买 医保医疗协同 

分 类 号：R197[医药卫生—卫生事业管理]