我国医保支持医养结合服务的政策分析

Policy Analysis of Medical Insurance Supporting Integrated Medical and Elderly Care Services in China

目的:分析我国医保支持医养结合服务的相关政策,为完善医养结合政策及推进医养结合服务提供参考。方法:以国家层面颁布的医保支持医养结合服务的政策文件为研究对象,采用内容分析法,对颁布时间、政策力度、颁布主体、医保支持医养结合服务的具体规定进行量化分析。结果:2013—2023年,国家层面颁布了16项相关政策,年均颁布1.45项政策。政策力度的平均值为2.25。国务院及部委均颁布了8项政策,部委颁布的8项政策中的7项为联合发文,占87.50%。16项政策中,对纳入医保支付的服务机构、服务项目、服务对象3个方面均有规定的政策有3项,占18.75%;两项政策涉及医保基金监管,占12.50%;1项政策对医保支付方式提出指导意见,占6.25%。结论:政策颁布的持续性较好,政策制定过程中部门间协同性较好。医保支持医养结合服务的政策有待在实施中细化,医保基金监管亟待加强,医保支付方式需进一步优化。

Objective:The paper analyzes policies about medical insurance supporting integrated medical and elderly care services in China to provide a reference for improving the policy and promoting the services.Method:China’s polices about medical insurance supporting integrated medical and elderly care services issued by the national government were taken as research object.The content analysis method was used to quantitatively analyze the issuing time,policy intensity,issuing subject,and specific regulations about medical insurance supporting integrated medical and elderly care services.Result:From 2013 to 2023,the national government issued 16 relevant policies,with an average of 1.45 policies issued annually.The average policy intensity is 2.25.The State Council and various ministries have issued 8 policies respectively.7 out of the 8 policies issued by the ministries are joint issuance,accounting for 87.50%.There are 3 out of 16 policies that have regulations on service institutions,service projects,and service recipients included in medical insurance payments,accounting for 18.75%.Two policies involve the supervision of medical insurance funds,accounting for 12.50%.One policy provides guidance on medical insurance payment methods,accounting for 6.25%.Conclusion:The continuity of policy issuance is good.There is good collaboration between departments in the policy-making process.The policy content about medical insurance supporting integrated medical and elderly care services needs to be refined through implementation.The supervision of medical insurance funds needs to be strengthened urgently,and the payment method for medical insurance needs to be further improved.