| 引用本文：罗琳彬,贺睿博,李浩淼,等.“强基层”导向下县域医保与医疗协同演进的多维嵌入机制研究：以重庆黔江为例[J].中国卫生政策研究,2025,18(7):1-8 |
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| “强基层”导向下县域医保与医疗协同演进的多维嵌入机制研究：以重庆黔江为例 |
| 投稿时间：2025-06-04 修订日期：2025-07-10 PDF全文浏览 HTML全文浏览 |
| 罗琳彬1，贺睿博2，李浩淼1,3，张亮1,3 |
| 1.武汉大学政治与公共管理学院 湖北武汉 430072;2.湖北经济学院医疗保险改革协同创新中心 湖北武汉 430205;3.武汉大学健康治理研究中心 湖北武汉 430072 |
| 摘要:本文立足基层卫生治理情境，运用嵌入性理论与激励机制理论，构建县域医保与医疗协同多维嵌入机制分析框架，以重庆黔江改革为案例，系统剖析医保基金嵌入基层服务体系的运行机制。研究发现，医保嵌入基层治理是一个以价值理念为牵引、社会结构为基础、制度环境为支撑，贯穿资源重构、关系重塑与利益调节的系统性嵌合过程。构建以基层医疗集团为单元的医保横向整合机制，有利于强化医保支付对基层服务特性的适配性；构建预算约束、结余激励与绩效反馈相衔接的制度闭环，有利于激发基层服务的内在动力；构建职责清晰、协同有序的多部门联动机制，有利于实现基金管理与服务供给的深度融合。 |
| 关键词:基层卫生治理 嵌入性理论 激励机制理论 医保与医疗协同 |
| 基金项目:国家自然科学基金面上项目（72474162）；国家自然科学基金青年项目（72104073） |
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| Multi-dimensional embedded mechanisms in the synergistic development of county health insurance and healthcare services under the “strengthening primary care” strategy： A case study of Qianjiang district， Chongqing |
| LUO Lin-bin1, HE Rei-bo2, LI Hao-miao1,3, ZHANG Liang1,3 |
| 1.School of Political Science and Public Administration， Wuhan University， Wuhan Hubei 430072， China;2.Medical Insurance Reform Collaborative Innovation Center， Hubei University of Economics， Wuhan Hubei 430205， China;3.Research Center for Health Governance， Wuhan University， Wuhan Hubei 430072， China |
| Abstract:This study draws on embedding theory and incentive mechanism theory to construct a multi-dimensional framework for analyzing the integration of county-level health insurance into primary healthcare. Using Qianjiang District， Chongqing， as a case study， it analyses how horizontally bundled funding and service transformation embed insurance into local health governance. The study finds that health insurance is embedded into primary governance through a systemic process driven by values， shaped by social structures， and supported by institutions， involving the reconfiguration of resources， relationships， and interests. Establishing primary care groups as budget units improves alignment between payment and service needs； linking budget limits， surplus incentives， and performance feedback strengthens provider motivation； and coordinated inter-agency mechanisms facilitate integration of fund management and service delivery. |
| Key words:Primary health governance Embedding theory Incentive mechanism theory Synergy between health insurance and healthcare services |
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