我国慢性病防控的医保支付政策分析

Analysis of Medical Insurance Payment Policies Related to Prevention and Control of Chronic Diseases in China

目的:梳理我国慢性病防控的医保支付政策,分析相关政策工具的使用情况,为后期政策的调整和优化提供参考。方法:在国务院、国家医疗保障局等官方网站检索慢性病医保支付相关政策,构建“基本政策工具-利益相关者”二维分析框架,从这两个维度对慢性病医疗保障政策进行分析。政策工具继续细分成17个次级条目,运用内容分析法分析其应用状况。结果:共梳理22份有关慢性病防控的医保支付政策文件,编码72条。分析得出需求型工具占40.28%、供给型工具占38.89%、环境型工具占20.83%;利益相关者涉及4个利益方,分别是政府、支付方、供给者、需求者,其中针对支付方的政策较多。结论:当前各部门政策侧重点不同,政策工具的应用情况呈非均衡性,需增加环境型政策工具的应用,创造良好的外部支持环境;加强供给型工具中人才队伍的建设、资金投入力度,直接推动慢性病防控;优化需求型工具的使用,拉动医疗保障内需。各利益相关者的政策关注度不够均衡,难以统筹兼顾,应加强跨部门合作,发挥政策合力,均衡应用各类政策工具。

Objective:To sort out the medical insurance payment policies related to the prevention and control of chronic diseases in China,and to analyze the use of policy tools,so as to provide references for the adjustment and optimization of policies in the future.Methods:The policies related to the medical insurance payment of chronic diseases by visiting the official websites of the State Council,National Healthcare Security Administration and so on were searched.This paper constructed a two-dimensional analysis framework including basic policy tools and stakeholders and analyzed the healthcare security policies of chronic diseases from the two dimensions.The policy tools continued to be subdivided into 17 sub-items,and the application status was analyzed by content analysis.Results:22 policy documents of medical insurance payment related to the prevention and control of chronic diseases were sorted out with 72 codes.The analysis showed that demand tools accounted for 40.28%,supply tools accounted for 38.89%and environmental tools accounted for 20.83%.There were four stakeholders including the government,the payer,the supplier and the demander,and there were more policies involving the payer.Conclusion:Each department has different policy emphases at present and the application of policy tools is unbalanced.It is necessary to increase the application of environmental policy tools and create a good external support environment,strengthen the construction of talent team and capital investment in supply tools to directly promote the prevention and control of chronic diseases,and optimize the use of demand tools to stimulate the domestic demand of healthcare security.The policy attention of various stakeholders is not balanced enough to make overall plans.It is suggested that all departments need to strengthen cooperation,combine policy advantages and coordinate the use of various policy tools.