医保统筹层次提高背景下委托代理问题及优化路径研究

Research on Principal-agent Problems and Optimization Under the Background of Centralizing Fund Management of Basic Medical Insurance

本文基于委托代理理论,通过风险转移契约模型和棘轮效应模型,探讨医保统筹层次提高后下级政府放松监管的行为逻辑,并从激励与监管角度提出了相应的改进路径。研究发现,医保统筹基金财权和事权相分离的管理模式,会导致下级政府放松对地方医保基金的监管力度,从政府治理方式、基金管理模式、医药卫生体制改革等角度提出改善建议。

Based on the framework of principal-agent theory, this paper discussed the lower-level government’s behavior logic of deregulation under the background of centralizing fund management of basic medical insurance with the risk transfer contract model and ratchet effect model to propose corresponding improvement paths from the perspective of incentive and supervision. The paper found that separating the financial and administrative powers would lead to the relaxation of the fund supervision by lower-level governments and put forward suggestions for improvement from the perspective of governance mode, fund management mode, and medical and health system reform.