| 引用本文：孟庆跃.复杂系统治理视角下医疗与医保协同整合[J].中国卫生政策研究,2025,18(5):1-5 |
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| 复杂系统治理视角下医疗与医保协同整合 |
| 投稿时间：2025-04-16 修订日期：2025-05-08 PDF全文浏览 HTML全文浏览 |
| 孟庆跃1,2,3 |
| 1.北京大学中国卫生发展研究中心 北京 100191;2.海南健康发展研究院 海南海口 570311;3.海南医科大学管理学院 海南海口 571199 |
| 摘要:本文基于复杂系统治理理论，剖析我国医疗与医保体系在政策目标、管理逻辑、资源配置及运行机制等方面存在的制度分化与协同不畅等问题，这些问题主要体现在控制机制薄弱、沟通机制低效、协调机制不畅和整合机制缺位等方面，制约了医疗与医保整体治理效能的提升。本文提出以下对策建议：一是推动医疗与医保管理制度深度整合，强化“以健康为中心”的政策导向；二是促进医疗与医保支付制度协同，充分发挥其在构建优质高效医疗卫生服务体系中的关键作用；三是提升医疗与医保沟通效率，构建覆盖全生命周期一体化的健康信息平台；四是完善医疗与医保权力制衡机制，构建现代化筹资与服务治理体系。 |
| 关键词:复杂系统 治理 医疗与医保 协同整合 |
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| Coordination and integration of medical care and insurance systems from the perspective of complex system governance |
| MENG Qing-yue1,2,3 |
| 1.China Center for Health Development Studies， Peking University， Beijing 100191， China;2.Hainan Institute of Health Development Studies， Haikou Hainan 570311， China;3.Hainan Medical University， Haikou Hainan 571199， China |
| Abstract:Based on complex system governance theory， this article analyzes the major issues of coordination and integration of medical care system and social medical insurance system， indicating that the mechanisms of control， communication， coordination and integration are not well established. Four policy recommendations are suggested： deepening integration of medical care and insurance systems to better achieve "health-centered" strategy， promoting coordination in reform of provider payment systems to leverage their role in construction of high-quality and efficient medical care， improving efficiency of communication to build a more integrated health information platform， and improving the power balance between medical care system and medical insurance system to adopt advanced financing and service governance system. |
| Key words:Complex system Governance Medical care and insurance Coordination and integration |
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