中国医保医师制度建设可行性分析

Feasibility analysis of the construction of healthcare insurance physician system in China

随着我国全民医保制度不断完善,对医保基金使用的监管提出更高要求。中国医保医师制度建设具有逻辑可行性、政策可行性与法理可行性,表现在:逻辑层面,中国医保医师制度是执业医师制度的延伸;政策层面,中国医保医师制度的建立已有政策铺垫及其改革基础;法理层面,医保监管从医疗机构延伸到医师合理合法。建立与实施中国医保医师制度,需健全医保经办机构、医疗机构的职能职责,建立全方位监管体系并与现行政策制度相互配合、综合施策,将有力促进监管对象从医疗机构延伸至医务人员,打破地区间医保医师的管理壁垒,对于增强医师行为监管的连续性,提高医保基金使用效率,实现资源有机整合与综合有效监管,推动医疗、医保、医药、医师四方联动,提供价值医疗服务具有重要意义。

With the continuous optimization of the universal medical insurance system in China,higher requirements are put forward for the vigilant supervision of medical insurance funds utilization.The construction of healthcare insurance physician system achievement is manifested in three aspects,including logical feasibility,policy feasibility and legal feasibility.These aspects are extended as follows:the healthcare insurance physician system is an extension of the medical practitioner system on the logical level;at the policy level,the establishment of healthcare insurance physician system has laid the foundation of the existing policies and related reforms in China;and on the legal level,it is reasonable and legal that the supervision of medical insurance extends from institutions to physicians.In order to establish and implement national healthcare insurance physician system,it is necessary to improve the functions and responsibilities of medical insurance companies and healthcare institutions,an all-round supervision system and cooperate with the current policy system and comprehensively implement policies and systems,which will effectively promote the supervision objects extend from medical institutions to medical staff,break the regional management barriers.It is of great significance to improve the utilization efficiency of medical insurance funds,realize the organic integration and comprehensive effective supervision of resources and allocation strategies,promote the quartet joint reform of medical treatment,medical insurance,medicines supply and physicians,and provide valuable healthcare services.