2009—2020年我国医疗保障工作的重点与推进方向探究

Research on the focus and promotion direction of China’s medical security work from 2009 to 2020

为了解我国医疗保障制度的发展轨迹、施政重点与政策探索调整方向,文章基于扎根理论,借助NVivo12软件,采用定性与定量相结合的方法,以2018年5月国家医保局挂牌成立的时间为分界线,将2009—2020年国家各部门发布的医保相关政策文件分成前后两个阶段进行开放性编码。结果显示,经过三级开放性编码,2009年1月至2018年5月的政策文本提炼出91个概念、26个范畴,2018年6月至2020年12月的政策文本提炼出92个概念、29个范畴。对比两个阶段的开放性编码结果,分别从范畴层面和概念层面进行梳理与剖析可得到,国家医保局成立后年均政策发布数量是之前的3.2倍,主要在“医药服务供给侧改革”“医疗保障公共管理服务”和“待遇保障机制”三个领域较之前有较大幅度的调整。

In order to understand the development trajectory,policy focus and policy exploration and adjustment direction of China’s medical security system,based on the grounded theory,with the help of NVivo12 software,this study used a combination of qualitative and quantitative methods to analyze the medical insurance related policies issued by various national departments from 2009 to 2020. The study took the time when the National Healthcare Security Administration was established in May 2018 as the dividing line to classify policy documents into two stages for open coding. The results showed that after three-level open coding,91 concepts and 26 categories were extracted from the policy texts from January 2009 to May 2018,and 92concepts and 29 categories were extracted from the policy texts from June 2018 to December 2020. Comparing the open coding results of the two stages,and sorting and analyzing them from the category level and the conceptual level,it can be found that the average annual number of policy releases after the establishment of the National Healthcare Security Administration was 3.2 times larger than that of the previous ones. Policies in the following three areas have been significantly adjusted compared with the previous ones,i.e.“supply-side reform of medical services”“medical security public management services”and“reimbursement guarantee mechanism”.