论我国医保服务管理参与权的二元社会化配置——以制度效能为视角的分析

On the Dual Socialized Allocation of the Participation Rights to Governance and to Service Delivery in China's Health Insurance System

医保服务权及管理权之配置应以相应参与权的配置为前提,医保服务及管理之参与权的社会化配置改革具有法理上、政治上和经验上的正确性。配权目标有二:在基本制度方面,赋予社会机构以参与医疗保险服务的权利,并依据该参与权利依法取得医疗保险服务权和附属的管理权;在具体制度方面,分解政府办医疗保险机构的内部治理管理权,赋予社会组织和个人以参与治理管理的权利。社会化配权和社会参权有助于实现公立医疗保险机构的内部科学治理和外部有效竞争,并依此改善医疗保险机构的服务管理能力和效益。

The rights to the service delivery and to governance in the SHI system should be reallocated on the premise of the allocation of the right to participation, which has its correctness in legal, political and experimental facets. The furthering reform should be pushed forward in two levels which includes empowering social organs to participate in the service delivering and to possess the power of administration related in the macro-level and empowering the social organs and individuals to participate in the public governance to state-owned SHI institutions in micro-level. The ability and effectiveness of SHI service delivery which resulted from scientific governance and competition could be enhanced by the reallocation of the participation rights to co- governance and to service delivery.