医保协议法律性质探索——兼谈医保社会治理

Exploration on the Legal Nature of Medical Insurance Agreements——Discussions on Social Governance of Medical Insurance

目前对医保协议法律性质的探讨多囿于二元法律结构,导致协议主体定位混乱、权利义务分配不清,影响医保协议制度的落实。本文认为:医保协议的签订主体虽然只有医保机构和医疗、药品等定点供给机构,但其所保护和协调的利益是多方的,将行政私法理论引入医保协议以界定其法律性质,能够充分反映“医保协议”内涵及其特征,因而医保协议的法律性质应是行政私法合同。

At present,the discussion on the legal nature of medical insurance agreement is restricted to the dual legal structure,which leads to the confusion of the positioning of the main body of the agreement,the unclear distribution of rights and obligations,and affects the implementation of the medical insurance agreement system.This paper argues that although the signing bodies of the medical insurance agreement only include the medical insurance institutions and designated providers of medical drugs,the interests they protect and coordinate are multi-faceted,and introducing the theory of private administrative law into the definition of the legal nature of medical insurance agreement can fully reflect its connotation and characteristics,therefore,its legal nature is administrative private law contract.