| 引用本文：李珍, 陈晋阳, 王红波.医保基金战略购买：基本概念、国际经验与中国镜鉴[J].中国卫生政策研究,2021,14(5):1-7 |
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| 医保基金战略购买：基本概念、国际经验与中国镜鉴 |
| 投稿时间：2021-03-16 修订日期：2021-05-14 PDF全文浏览 HTML全文浏览 |
| 李珍, 陈晋阳, 王红波 |
| 中国人民大学公共管理学院 中国人民大学健康保障研究中心 北京 100872 |
| 摘要:中国特色医保基金战略购买是一个在“前瞻、系统、整体”战略视角指导下，以医保基金为购买主体，医疗服务为购买客体，追求医疗服务体系结构优化、国民健康收益结构优化的动态、循证、优化过程。战略购买在欧洲地区的实践效果不佳，本文以NHS英格兰为例对其政策实践和失败原因做了梳理总结，认为其主观上的改革理念彷徨、客观上的供需力量失衡是主要原因。结合国际经验、立足中国情境，本文进一步从“谁来购买、为谁购买、购买什么、如何购买、怎样支付”五个方面对中国特色医保基金战略购买的具体内容做了初步探讨。 |
| 关键词:医保基金战略购买 国民健康服务体系 供需分离 整合型医疗体系 |
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| Strategic purchasing of medical insurance fund: Basic concepts, international experiences and future practices of China |
| LI Zhen, CHEN Jin-yang, WANG Hong-bo |
| Health Security Research Center, School of Public Administration and Policy, Renmin University of China, Beijing 100872, China |
| Abstract:Strategic purchasing of medical insurance fund with Chinese characteristics is an evidence-based and dynamic optimization process under the guidance of a "forward-looking, systematic and holistic" strategic perspective. In this regard, the medical insurance fund is taken as the main purchaser and the medical service system as the purchase object. This helps to pursue the optimization of the structure of medical service system and the equity distribution of national health benefits. Strategic purchasing in Europe is not effective in practice. Taking National Health Service (NHS) England as a research sample, this paper summarizes its policy practice and draws the reasons for its failure. With the results of the research, it is believed that the subjective uncertainty of the reform concept and the objective power imbalance between the supply and demand sides constitute the main reasons for the failure of strategic purchasing NHS England. Combining international experience and basing on native context of China, the specific contents of strategic purchasing of medical insurance fund with Chinese characteristics is further discussed from five aspects, namely, "who buys, for whom, what to buy, how to buy, and how to pay". |
| Key words:Strategic purchasing of medical insurance fund National health services Purchaser-provider split Integrated care system |
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