新形势下我国医保治理模式的选择

The Trend of Governance Mode of China's Medical Insurance System under the New Situation

我国医疗保障的制度主体是社会保险模式,这一模式要求形成社会化的治理模式,与服务供给方形成平等交易、购买服务的关系。这必然要求服务供给方的多元供给以及供方竞争。但我国医疗服务的供给方仍然是行政化、计划化的治理模式。治理模式之间的冲突构成了二十年来我国医药卫生体制改革的主线索。国家医保局的成立重新明确了社会医疗保险的制度安排,由此必然要求在治理上形成社会化的治理模式。形成社会化的治理模式的核心和关键是公立医疗机构的去行政化改革。而医保推动公立医疗机构去行政化改革的契入点则在于医保医师与医保药师制度建设。

The main system model of medical security in China is the social insurance model, which calls for the formation of a socialized governance model, and the relationship of equal transaction and purchase of services with the service provider. This will inevitably require a pattern of multiple supply and supplier competition. However, the supply side of our medical service is still in bureaucratic and planned governance mode. The conff ict between this mode of governance constitutes the main thread of the reform of medical and health system in China in the past twenty years. The establishment of the National Healthcare Security Administration has redeff ned the institutional arrangement of social medical insurance, which inevitably requires the formation of a socialized governance model. The core and key to form a socialized governance mode is the de-administration reform of public medical institutions. The point of penetration that medical insurance promotes the de-administration reform of public medical institutions lies in the construction of medical insurance physician and medical insurance pharmacist system.