新医改的区域选择、操作规程与政策匹配:粤省个案

Sector Selection,Operating Process and Supporting Policies of New Medical Reform:An Example from Guangdong Province

基于改革的制度逻辑矫正,以及一系列政策措施来推进医疗医保体制机制和管理与服务创新,可有效达成新医改的区域整合制度安排。"湛江模式"的实质是引入社保基金的增值业务托管或增值再保险,建立微利型专业健康险代理制,继而尝试构建公共医疗医保的协同增值服务体系,核心是实现"二次增值险+第四方协同服务"的城乡一体化健康保障普惠模式。此模式不仅为我国新医改的区域选择提供了成功样本,也为其他社会公共领域改革提供了借鉴。

Based on the reform of the system of the logic correction,and a series of policies and measures to promote medical security system mechanism and management and service innovation,which can effectively achieve new medical reform regional integration system arrangement.The essence of ＂Zhanjiang mode＂ is to set up micro profit professional health insurance agency system by introducing social security fund value-added custody or value-added reinsurance.It tries to establish public medical and health care collaborative value-added service system,finally to realize the universal health insurance of integration of urban and rural areas.The core is the realization ＂secondary value-added risks ＋ the fourth party collaborative services＂ of the urban and rural integration of the universal health insurance benefit pattern.This model is provide a successful sample not only for the country＇s new medical reform area selection,but also some reference for other social publicsector reform.