自治与竞争:德国法定社会医疗保险治理的历史演进与选择逻辑  

Autonomy and competition:the historical evolution and selection logic of German statutory social healthcare insurance governance

作　　者：刘德浩[1] LIU Dehao

机构地区：[1]海南大学国际旅游与公共管理学院,海南海口570228

出　　处：《社会保障研究》2024年第6期98-110,共13页Social Security Studies

基　　金：国家社科基金一般项目(20BRK035)的阶段性成果。

摘　　要：德国法定社会医疗保险制度建立140余年来,疾病基金一直是管理运营主体。受历史传统、政治、文化等多重因素共同作用,德国形成了兼具市场竞争性和国家干预性特征的自治管理模式。20世纪90年代初,德国开始推动法定社会医疗保险政策和治理模式的调整,疾病基金间竞争机制的引入成为提高治理绩效的路径选择,而价格竞争机制、风险调整机制和选择性合同是竞争秩序和效率实现的前提。我国共建共治共享的医保治理格局尚未形成,借鉴德国经验,当前优化医保治理格局需重点关注三个方面:厘清政府职责,实现“管办分离”;深化医保支付方式改革,构建公共契约模式;借助第三方力量,提高决策的科学性和中立性;搭建利益协商平台,提高治理韧性。Over 140 years since the foundation of the legal social medical insurance system in Germany,the disease funds have been the main management and operation entities.Influenced by multiple factors such as historical tradition,politics,and culture,an autonomous management model of medical insurance governance was formed,which combined the characteristics of market competitiveness and state intervention.In the early 1990s,Germany began to promote the adjustment of statutory social medical insurance policies and governance models,and competition among the different disease funds became the path choice to improve governance performance.Price competition mechanism,risk adjustment mechanism,and selective contract are the prerequisites for achieving competitive order and efficiency.The medical insurance governance pattern of co-construction,co-governance and sharing in China has not yet formed.Drawing on the experience of Germany,the current optimization of the medical insurance governance pattern needs to focus on the following aspects:clarifying government responsibilities and achieving"separation of regulation and operation";deepening the reform of medical insurance payment methods and constructing a public contract model;utilizing the third-party forces to enhance the scientific and neutral nature of decision-making;building a platform for negotiating interests and enhance governance resilience.

关 键 词：德国 医保治理 自治管理 历史演进 选择逻辑 

分 类 号：F27[经济管理—企业管理]