健康中国视角下医保基金与公卫资金统筹使用路径研究

The path of coordinated use of medical insurance funds and public health funds under the perspective of Healthy China

医保基金和公卫资金的统筹使用是促进服务融合、持续推进“健康中国”建设的驱动力。依据协同优势理论与PCIC理论,本研究提出了推动医保基金与公卫资金统筹使用的三大路径,即理顺购买内容、优化购买方式和强化购买能力。基于上述路径视角的研究发现,目前国内统筹使用的探索实践已取得一定成效,但也存在资金来源不明确、购买服务范围不清晰、多主体考核激励协调性不足,与健康产出关联性不强、成本核算与健康测量考核能力不足、信息系统互联互通不足等问题。建议完善顶层设计,建立与健康结果相关的考核支付激励机制,实现资金扩容与信息化的动态建设。

The integrated use of health insurance funds and public health funds is the driving force for promoting service integration and continuously advancing the construction of a“Healthy China”.Based on the synergistic advantage theory and the PCIC theory,this paper proposes three paths to promote the integrated use:rationalizing the functional position and service supply of the two parties,optimizing the payment and incentive mechanism,and strengthening the capacity building of service buyers.Based on the above path perspective,this paper finds that the current domestic exploration and practice of coordinated use has achieved certain results,but there are also problems such as unclear funding sources,unclear scope of purchased services,insufficient coordination of multi-subject assessment incentives,weak correlation with health outputs,insufficient cost accounting and health measurement assessment capabilities,and imperfect information system interconnection.It is recommended to improve the top-level design,establish an assessment and payment incentive mechanism related to health outcomes,and realize the dynamic construction of fund expansion and informatization.