我国基本医疗保险基金监管政策文本的量化分析

Quantitative Analysis on Policy Texts of Basic Medical Insurance Fund Supervision in China

目的以新医改为起始点,分析国家医保局成立前后我国国家级基本医疗保险基金监管政策的变化和特点,为改进医疗保障基金监管政策提供依据。方法采用内容分析等方法,构建“制定主体—参与主体—运用工具”分析框架对我国58份国家级基本医疗保险相关政策进行分析。结果国家医保局成立前,多部门联合和国务院发文最多,政府部门是主要参与主体,政策工具中命令型、规范型、激励型、能力建设型、系统变化型和劝说型分别占30.3%、22.3%、12.6%、18.9%、14.3%和1.7%;成立后,制定主体以多部门、国务院和国家医保局为主,参与主体增多,政策工具中命令型、规范型、激励型、能力建设型、系统变化型和劝说型分别占39.4%、17.2%、8.0%、17.5%、14.6%和3.3%。具体到各类政策工具内部,法规管制、目标规划、行政监督等数量增加,信息公开、监管绩效考核、医保支付相关制度改革等数量减少。结论政策制定主体逐步由多部门分散向协同联动方向转变,但协同性有待加强;参与主体趋向多元化,但利益关系有待协调;政策工具运用总体呈上升趋势,但内部均衡性不足。下一步需建立各方监管联动机制和利益诉求表达机制,调整与完善各类政策工具使用结构。

Objective Taking the new health care reform as the starting point,it analyzes the changes and characteristics of China’s National Basic Medical Insurance Fund Regulatory Policy texts with the establishment time of National Healthcare Security Administration as the demarcation point,and provide evidence on improving the medical insurance fund regulatory policy.Methods Using methods such as content analysis to build an analysis framework of“formulation subject-participants-using tools”to quantitatively analyze 58 Chinesepolicies at the national level.Results Before the establishment of the National Healthcare Security Administration,policies are mainly issued by multiple departments and the State Council.Government departments are the main participants.Among the policy tools,command type,standard type,incentive type,capacity building type,system change typeand persuasion type accounted for 30.3%,22.3%,12.6%,18.9%,14.3%and 1.7%respectively.After the establishment of the National Healthcare Security Administration,policies are mainly issued by multiple departments,the State Council and National Healthcare Security Administration.The number of policy participants has increased.Among the policy tools,command type,standard type,incentive type,capacity building type,system change type and persuasive type accounted for 39.4%,17.2%,8.0%,17.5%,14.6%and 3.3%respectively.Specific to the increase of various policy tools,the number of regulatory control and target planning,and the number of related system reforms,such as medical insurance payment,information disclosure,regulatory performance evaluation,and medical insurance payment.Conclusion The main body of policymaking is gradually shifting from decentralized multi-department to coordinated linkage,but the synergy needs to be strengthened;the participants are becoming diversified,but the interest relationship needs to be coordinated;the use of policy tools is generally on the rise,but the internal balance is insufficient.In the next step,it is necessary to establish the regulatory linkage mechanism and the interest appeal expression mechanism of all parties,and adjust and improve the use structure of various policy tools.