华西妇儿联盟多层次医疗保障体系的建设与运作

Construction and operation of the multi-level medical security system of the West China Women and Children Alliance

医疗互助是多层次医疗保障体系的重要组成部分。四川大学华西第二医院牵头建立儿科专科联盟"华西妇儿联盟",基于定制化、普惠性的相互保险产品"家庭医生互助计划",推动联盟产品形态、患者风险兜底、机构筹资造血、各方利益分配等关键环节落地,探索创新互助筹资、支付与激励机制,形成以互助计划为核心、"四位一体"持续运营的儿科分级诊疗服务闭环;激发医疗保险与服务供给体系的整合,同时强化相互保险与社会保障的协同作用,在联盟内形成以健康为中心的多层次医疗保障体系,为分级诊疗制度建设与探索提供参考。

Medical mutual aid is an important component of multi-level medical security system.West China Second University Hospital of Sichuan University led the establishment of the pediatric specialty alliance"West China Women and Children Alliance".Based on customized and inclusive mutual insurance product"Family Doctor Mutual Aid Plan",the alliance implemented key links such as mutual aid product forms,patient risk protection,institutional financing and hematopoiesis,and distribution of benefits to all parties,explored innovative mutual aid funding,payment,and incentive mechanisms,forming a closed-loop pediatric tiered diagnosis and treatment service system with the Mutual Aid Plan as the core.This system operated continuously under the"Four-in-One"framework,stimulating the integration of medical insurance and service supply systems while enhancing the synergistic effect between mutual insurance and social security.It has formed a distinctive health-centered multi-level medical security system within the alliance,and could provide reference for the construction and exploration of hierarchical diagnosis and treatment system.