基于多源流理论视域下我国医疗保险支付政策的变迁动力与优化路径  

The evolutionary forces and optimization pathways of China’s healthcare insurance payment policy from the perspective of the multiple streams theory

作　　者：王健 朱良英 郭彦虹 钱嘉琳 农圣 WANG Jian;ZHU Liangying;GUO Yanhong;QIAN Jialin;NONG Sheng(School of Public Health and Management,Youjiang Medical University for Nationalities,Baise,Guangxi 533000,China)

机构地区：[1]右江民族医学院公共卫生与管理学院,广西百色533000

出　　处：《中国农村卫生事业管理》2024年第9期627-632,共6页Chinese Rural Health Service Administration

基　　金：国家自然科学基金项目(72164036);广西壮族自治区教育厅研究生教育创新计划项目(JGY2021213)。

摘　　要：目的阐释医疗保险支付方式的变迁动力,为未来医保支付方式改革提供建议。方法运用多源流理论模型分析医疗保险支付方式政策变迁背后的主要动力。结果政治源流主导此次政策变迁,老龄和共病带来的新医疗挑战、内部经济压力和技术成熟与大局治理的共同作用为医保支付方式改革的核心动力。结论激发内部动力,解决老龄化和共病等社会环境压力下医保发展的最关键问题;疏解外部压力,提高政府决策效率、强化科技创新优化医保支付体系制度改革;借助政治动力,在建设现代化国家的大趋势和科学治理理念之下建设现代化医疗保障体系等方式可作为我国医疗保险支付政策变迁动力的优化路径参考。Objective To elucidate the dynamics of changes in health insurance payment modes and to provide suggestions for the future reform.Methods The multiple streams theory was used to analyze the main driving forces behind the policy change in health insurance payment modes.Results The political streams dominated the policy change,and the new healthcare challenges of aging and co-morbidities,internal economic pressures,and technological maturity and big-picture governance were the core driving forces of health insurance payment reform.Conclusions It is suggested to stimulate internal motivation to address the most critical issues in healthcare development under the pressure of aging and comorbidity in social environment,to alleviate external pressure to improve government decision-making efficiency and enhance technological innovation to optimize the payment reform of the healthcare insurance system,and to leverage political motivation to build a modern healthcare insurance system under the trend of building a modern nation and the concept of scientific governance,which can all serve as reference for optimizing the driving forces of the evolution of healthcare insurance payment policies in China.

关 键 词：医保支付 支付方式 多源流理论 城乡医保统筹 人口老龄化 分级诊疗 

分 类 号：R197.1[医药卫生—卫生事业管理]