价值回归:健康中国视域下门诊保障制度改革

Value Regression:Reform on Outpatient Care System from the Perspective of a Healthy China

健康保障,特别是医疗保障关乎亿万人民福祉,完善基本门诊保障,是新时代中国医保制度改革的重要抓手,也是建设健康中国的有力支撑。中国基本医疗保障制度的建立和演变是从住院保障逐步向住院、门诊“双统筹”发展的过程,相比于住院保障,门诊保障正处于改革关键期。门诊保障制度及实践在医保运行中发挥着基础、广泛的作用,须遵循“制度实践与价值取向相统一”的原则。一方面,制度实践是价值取向的外在反映;另一方面,内在价值取向是制度实践的有效内驱力,因此,要想有效发挥门诊保障制度效能,必须充分考察制度所蕴含的价值取向,即只有主动调试门诊保障制度运行的价值取向与实然状态,才能更好地发挥门诊保障制度优势。因此,通过以“制度运行及实践现状-存在问题及价值取向偏差-制度改革制约因素-价值回归及改革路径探索”为架构进行论述,重新审视基本医保门诊保障的实践现状以及实践中所展现的价值取向,发现门诊保障的制度结构分割与碎片化、基层执行主体服务能力薄弱、运行机制筹资与管理能力不足等问题,进而提出完善路径与治理措施,以期促进医疗保障高质量发展。

Health care,especially medical care,is of great importance to the well-being of billions of f people.Improving basic outpatient care is akey focus of the reform of China's medical insurance system in the new era,and it is also a strong support for building a healthy China.The establishment and evolution of China's basic medical insurance system has gradually shifted from inpatient guarantee to a“dual coverage”system that includes both inpatient and outpatient care.Compared to inpatient guarantee,outpatient guarantee is currently in a critical period of reform.The outpatient guarantee system and its practices play a fundamental and extensive role in the operation of medical insurance and should adhere to the principle of“unify of institutional practice with value orientation”.On one hand,institutional practices are an external reflection of value orientation,and on the other hand,internal value orientation is the effective internal driving force behind institutional practices.Therefore,in order to effectively utilize the efficiency of the outpatient guarantee system,it is necessary to fully consider the value orientation embodied in the system.That means actively adjusting the value orientation and actual state of the outpatient guarantee system,in order to better leverage its advantages.By discussing the current state of the current state of institutional operation and practice,identifying existing problems and deviations in value orientation,exploring the factors constraining institutional reform,and proposing a path for value reorientation and reform,we can re-examine the practical status of outpatient support and its value orientation.This includes issues such as fragmented institutional structure,weak service capacity in the comunities,and inadequate funding and management capacities in the operation mechanism.Furthermore,we can provide improvement paths and governance measures,aiming to continuously lead the high-quality development of medical care.