| 引用本文：邢怡青, 贺睿博, 李浩淼, 张亮.县域医保支付与医疗服务结构适配关系与机理——基于云县典型案例的分析[J].中国卫生政策研究,2023,16(5):1-7 |
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| 县域医保支付与医疗服务结构适配关系与机理——基于云县典型案例的分析 |
| 投稿时间：2023-02-22 修订日期：2023-04-18 PDF全文浏览 HTML全文浏览 |
| 邢怡青1,2, 贺睿博1,2, 李浩淼1,2, 张亮1,2 |
1. 武汉大学政治与公共管理学院 湖北武汉 430072;
2. 武汉大学健康治理研究中心 湖北武汉 430072 |
| 摘要:医保与医疗系统协同被视为促进卫生服务体系优化的关键手段，现有研究往往忽视了两个子系统之间的协同。本研究以云县医共体为研究范本，以适配理论为依据，构建医保支付与医疗服务的跨系统适配分析框架，纵向梳理系统适配路径，揭示适配机理。研究发现，两个子系统间主要有三种适配模式，呈现向下一阶段演进的特征；跨系统适配是一个多因素调节的互动过程，子系统适配地位具有非对等性，呈现“服务优先变革—保障适应调整—服务结构转变—医保引导行为”的全景。本研究对于中国特色医保支付方式适配改革具有一定参考价值，有利于形成中国式现代化县域卫生治理的有益经验，推进新时代县域卫生服务高质量发展。 |
| 关键词:县域 医保支付 医疗服务结构 跨系统适配模型 适配关系 |
| 基金项目:国家自然科学基金重点项目(71734003) |
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| The relationship and mechanism of county health insurance payment and medical service structure adaptation: Analysis based on a typical case in Yun county |
| XING Yi-qing1,2, HE Rui-bo1,2, LI Hao-miao1,2, ZHANG Liang1,2 |
1. School of Politics and Public Administration, Wuhan University, Wuhan Hubei 430072, China;
2. Center for Health Governance Research, Wuhan University, Wuhan Hubei 430072, China |
| Abstract:Synergy between health insurance and medical system is regarded as a key means to promote the optimization of health service system, and existing studies have neglected the synergy and reflection between the two subsystems. Taking Yun county Medical Community as a research model, we construct a cross-system adaptation analysis framework of health insurance payment and medical services based on adaptation theory, longitudinally sort out the system adaptation paths and reveal the adaptation mechanism. The study finds that there are three main adaptation modes between the two subsystems, which show the characteristics of evolution to the next stage; the cross-system adaptation is a multi-factor adjustment process, and the subsystem adaptation status is non-reciprocal, showing a panorama of “service priority change-adaptation of coverage, service structure change-medical insurance guiding behavior”. This study is valuable for the reform of health insurance payment method adaptation with Chinese characteristics, and also contributes to the formation of useful experience in modernizing county health governance in Chinese style and promoting high-quality development of county health services in the new era. |
| Key words:County Health insurance payment Medical service structure Cross-system adaptation model Adaptation relationship |
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