医保基金监管政策议题属性、演进趋势与知识生产  

Issue characteristics,evolutionary trends,and knowledge production in health insurance fund regulation policies

作　　者：杨赐然 肖琳琪 吴若男 王瑞 赵秋玲 段凤然 王越 毛宗福[3] 崔丹[1] Yang Ciran;Xiao Linqi;Wu Ruonan;Wang Rui;Zhao Qiuling;Duan Fengran;Wang Yue;Mao Zongfu;Cui Dan(School of Public Health,Wuhan University,Global Health Institute,Wuhan University,Wuhan 430071,China;Institute of Hospital Management,Wuhan University,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Dong Fureng Institute of Economic and Social Development,Wuhan University,Wuhan 430072,China)

机构地区：[1]武汉大学公共卫生学院武汉大学全球健康研究中心,武汉430071 [2]武汉大学中南医院武汉大学医院管理研究所,武汉430071 [3]武汉大学董辅礽经济社会发展研究院,武汉430072

出　　处：《中华医院管理杂志》2024年第4期316-322,共7页Chinese Journal of Hospital Administration

摘　　要：医保基金监管是医疗保障治理现代化中的一个重要议题,其作为医疗保障行政部门的首要任务在政策实践中不断得到确认和强化。本研究聚焦2018年国家医保局成立以来至2024年3月颁布的22份医保基金监管专项政策,深度剖析其议题属性,归纳总结政策变迁的演进趋势以及政策制定、执行和反馈过程中存在的知识生产模式。通过分析发现,不同的议题属性使得医保基金监管政策存在异质性面向,政策的发展过程呈现出鲜明的复合化演进趋势,主要体现在监管体系与监管内容的综合化、专业力量与社会力量的融合化、专项治理与常态监管的并行化以及常规手段与新兴手段的互补化4个方面。另外,贯穿于政策演化之中的知识生产存在4个不同面向,即问题纠偏、规范设定、试点经验和技术吸纳,与议题属性和政策演进三者共同构成了一个综合、动态而又开放的知识生产系统,持续推动政策的更新迭代。Health insurance fund regulation(HIFR)is a vital issue in the modernization of healthcare security governance,with its importance as a primary task of the healthcare security department continually reinforced in policy practice.This study focused on the 22 specialized policies issued by the National Healthcare Security Administration from its establishment in 2018 to March 2024,deeply analyzed their issue characteristics,and summarized the evolutionary trends of policy changes,as well as the knowledge production patterns that existed in the series of policy formulation,implementation,and feedback processes.Our analysis revealed that the diverse issue characteristics had led to heterogeneous directions in HIFR policies.The policy development process presented distinct composite evolutionary trends,mainly manifested in four aspects:the integration of regulatory system and content,the convergence of professional and societal forces,the parallelism of special governance and regular supervision,and the complementarity of conventional and emerging methods.Additionally,the study demonstrated that the knowledge production embedded in policy evolution encompassed four different dimensions:problem rectification,norm setting,pilot experience,and technical absorption.Together with issue characteristics and policy evolution,they formed an integrated,dynamic,and open system of knowledge production,continuously promoting the renewal and iteration of regulation policies.

关 键 词：医保基金监管 政策研究 政策议题 政策演进 知识生产 

分 类 号：R197.1[医药卫生—卫生事业管理]