改革开放以来的社会医疗保险制度改革:政策范式转移与制度约束

Social Health Insurance Reform since China's Reform and Opening-up: Policy Paradigm Shift and Institutional Constraints

医疗卫生体系转型与绩效提升对健康中国建设具有重要意义。为更好地解释改革开放以来我国医疗卫生体系转型改革中,财政投入增长迅速、政策创新经验突出,而医疗费用风险保护水平改善有限的现象,本文在医疗卫生体系政策分析框架下,审视改革开放40年来社会医疗保险制度改革所经历的政策范式转移。2003年以来,我国医疗卫生体系的目标由为经济政策与经济增长服务转向提高患者医疗费用风险保护水平,这意味着医疗卫生体系的政策范式转移开始启动。在由国家医疗卫生体系模式向社会医疗保险体系模式转型的过程中,地方政府竞争与部门利益及绩效竞争约束了政策目标和管制机制在政策执行中的转变。

Healthcare system transformation and performance improvement are of great significance to the implementation of the Healthy China strategy.Since China's reform and opening-up,the growing fiscal input and policy innovations have been accompanied by the lack of financial risk protection.From the perspective of comparative healthcare systems,this paper aims to examine the process of policy change,identify the key policy paradigm shift,and finally to provide an interpretation of the above-mentioned policy phenomena.The healthcare system reform since 2003 began to depart from the approach of developmental social policy by achieving universal health coverage and launching the New Healthcare Reform,triggering a policy paradigm shift from national health services to social health insurance system.In this process,local government competition and fragmented healthcare administration structure constitute institutional constraints on policy implementation.