走向“全民健康覆盖”——有效的规制与积极的战略性购买

发布时间：2019-08-07 20:31

【摘要】：实现"全民健康覆盖"是全球医改的根本目标,其关键首先是实现社会医疗保险的全民覆盖,其次是政府"管家"角色的有效发挥。政府的管家角色主要包括有效的规制与积极的战略性购买,前者的核心是市场化与公共定价相结合的价格规制而不是行政定价,积极的战略性购买关注于竞争性的合同购买、多元组合的医保支付体系、基于市场绩效的经济激励机制、公立医疗机构的法人化治理、以基层为重点的服务购买。自2009年实施"新医改"以来,我国在推进全民医保上取得了明显成效,但在医药、医疗方面的改革由于采取了"行政化"取向的措施,导致改革效果并不理想并造成了"政府的不当管制",业已成为当前医疗卫生体制所有问题的主要根源。进一步深化医改必须"以去行政化和强基层为重点"推进"三医联动改革",在医保方面重点推进制度整合并轨与完善医保多元组合支付方式,在医药方面重点建立市场化与公共谈判相结合的定价与采购机制,在医疗方面重点提升基层医疗卫生服务能力("强基层")与推进公立医院去行政化改革。
[Abstract]:The realization of "universal health coverage" is the fundamental goal of global health care reform. The key is to realize the universal coverage of social health insurance, and secondly, to give full play to the role of government "housekeeper". The role of government housekeeper mainly includes effective regulation and active strategic purchase, the core of the former is the combination of marketization and public pricing price regulation rather than administrative pricing, positive strategic purchase focuses on competitive contract purchase, multiple combination of medical insurance payment system, economic incentive mechanism based on market performance, legal governance of public medical institutions, service purchase with emphasis on grass-roots level. Since the implementation of the "new medical reform" in 2009, China has achieved remarkable results in promoting universal medical insurance, but the reform in medicine and medical care has taken measures of "administrative" orientation, which has led to the unsatisfactory effect of the reform and the "improper regulation of the government", which has become the main source of all the problems in the current medical and health system. In order to further deepen the medical reform, we must "focus on de-administrative and strong grass-roots level" to promote the "linkage reform of the three doctors", focus on promoting the integration of the system and perfecting the multiple combination payment mode of medical insurance, establish the pricing and procurement mechanism combining marketization with public negotiation in the aspect of medicine, focus on improving the capacity of primary medical and health service ("strengthening the grass-roots level") and promoting the reform of de-administration of public hospitals in the aspect of medical care.
【作者单位】：浙江大学公共管理学院;
【基金】：国家自然科学基金项目“政府购买基本医疗服务的可行性及其运行机制设计:基于浙江省的研究”(编号:71203194)资助的后续研究成果
【分类号】：R197.1

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