整体性治理视角下的城乡医保管理体制整合

发布时间：2018-05-05 20:51

本文选题：城乡医保管理体制 + 整合　；参考：《中共福建省委党校学报》2017年10期

【摘要】：城乡医保从制度构建之初就形成"碎片化"管理格局,几次被提上医保整合的政策议程,皆因缺乏成熟理论、模糊探讨而未能达成城乡医保管理体制整合的共识,致使城乡医保管理体制仍"整而未合"。作为解决政府"碎片化"管理问题的整体性治理理论,从治理理念、治理思维、治理目标与治理机制几方面为城乡医保管理体制整合提供了重要启示。基于整体性治理理论的指导,城乡医保管理体制整合应以公民医保需要为导向,建立网络型的医保管理结构,构建城乡医保决策、管理、监督三权制约与平衡机制,整合城乡医保信息管理系统和智能监控平台,建立医保患三者间的利益制衡与激励机制,构建政府首脑负责的城乡医保管理整体性协调机制,从而推动城乡医保有效整合以实现整体性治理。
[Abstract]:From the beginning of the system construction, urban and rural medical insurance has formed a "fragmented" management pattern. Several times it has been put on the policy agenda of medical insurance integration. Due to the lack of mature theory and fuzzy discussion, it has failed to reach a consensus on the integration of urban and rural medical insurance management system. As a result, urban and rural health care management system is still "integrated and not in line." As a whole governance theory to solve the government's "fragmentation" management problem, it provides important enlightenment for the integration of urban and rural medical insurance management system from the aspects of governance concept, governance thinking, governance goal and governance mechanism. Based on the guidance of holistic governance theory, the integration of urban and rural medical insurance management system should be guided by the needs of citizens' medical insurance, establish a network medical insurance management structure, construct the decision-making, management and supervision of the three powers of urban and rural health insurance control and balance mechanism. Integrating the urban and rural medical insurance information management system and intelligent monitoring platform, establishing the interest balance and incentive mechanism between medical insurance and patients, and constructing the overall coordination mechanism of urban and rural health insurance management, which the head of government is responsible for. So as to promote the effective integration of urban and rural health care to achieve holistic governance.
【作者单位】：山西大学;
【基金】：国家社会科学基金重点项目“整合城乡基本医疗保险的法律制度研究”(项目编号:13AFX027) 山西省软科学项目“‘互联网+’推动山西医保经办服务发展研究”(项目编号:2017041035-1)的研究成果
【分类号】：F842.684;R197.1

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