助推理论背景下医保服务医师管理制度的反思与重构

Reflection and Reconstruction of Medical Insurance Service Doctor’s Management System in the Context of Nudge Theory

医保服务医师管理制度面临着混淆相关法律关系、缺乏上位法依据、合法性遭受质疑的法治困境。这种强干预的方式一定程度上侵犯了临床自治和医师自主权,给医患关系带来新的挑战。过度规制可能导致无法享受从医学生物技术进步中获得疾病治疗的益处。据此,应该引入助推理论及其中的“警告”工具。建议医保部门与定点医疗机构签订协议时,要求医院必须建立预警系统,以期实现在法治框架内调和医师自治及医保医师强干预。严格划清诊疗活动和临床研究之间的界限,卫生健康、医疗保障、药品监督管理、发展改革、财政等监管部门之间应该建立沟通协商机制。完善医保医师奖惩制度,建立一种从轻到重、从间接到直接、从柔性到刚性的规制工具体系。

The medical insurance service physician management system is faced with the legal dilemma of confusing the relevant legal relations,lacking the basis of superior law,and questioning the legality.This kind of strong intervention violates clinical autonomy and physician autonomy to some extent,and brings new challenges to doctorpatient relationship.Excessive regulation may lead to an inability to enjoy the benefits of disease treatment derived from advances in medical biotechnology.Therefore,the nudge theory and its"warning"tool should be introduced.It is suggested that when medical insurance departments signs agreements with designated medical institutions,hospitals should be required to establish an early warning system,in order to achieve harmonization of physician autonomy and strong intervention by medical insurance physicians within the framework of the rule of law.It strictly draws the line between clinical activities and clinical research.A communication and consultation mechanism should be established between regulatory departments in areas such as health,medical security,drug supervision and administration,development and reform,and finance.The reward and punishment system for medical doctors should be improved to establish a regulatory tool system from light to heavy,from indirect to direct,and from flexible to rigid.