基于政策工具视角分析我国国家级医疗保险政策文本

Analysis on China’s national health insurance policies:based on policy instrument

目的分析我国国家级医疗保险政策文本的构成特点和存在问题,为进一步深化我国医疗保障制度改革提供依据。方法利用网络爬虫工具,系统检索2009—2017年我国发布的国家级医疗保险政策文本,以Rothwell&Zegveld政策工具模型为理论框架,分析政策文本中供给型、需求型和环境型政策工具的构成及特点。结果共纳入47份政策文本,其中2009年发布最多,多部门联合发布的政策文本所占比例最高。供给型政策工具所占比例为38. 79%,环境型为33. 64%,需求型为27. 57%;供给型政策工具中信息支持所占比例最高,需求型政策工具中补偿方案所占比例最高,环境型政策工具中功能监管所占比例最高。结论供给型政策工具对人才培养和保险产品的关注较少,应加强人才培养,并加快多层次多样化医疗保障体系建设;需求型政策工具总体应用较少,应提高这类政策工具的应用,并完善医保中的转诊政策;法规管制和考核评估等环境型政策工具的应用欠缺,应健全医保法制化建设,并完善考核评估。

Objective To analyze the structure and existing problems of China’s national health insurance policies,provide evidence on further improving China’s health insurance system.Methods The SEO Spider Tool was used to systematically retrieve all the national health insurance policies from 2009 to 2017,and we categorized and analyzed supply policy,environment policy and demand policy instruments based on the policy instrument analysis model by Rothwell&Zegveld.Results Within the 47 included policies,most were issued in 2009,and those issued by multi-department were the most.Supply policy instruments took up 38.79%,environment policy instruments were 33.64%,and demand policy instruments were 27.57%.Information support accounted for the highest proportion in the supply policy tool,compensation scheme accounted for the highest proportion in the demand policy tool,and functional supervision accounted for the highest proportion in the environmental policy tool.Conclusion Supply policy tools pay less attention to personnel training and insurance products,so we should strengthen personnel training and accelerate the construction of multi-level and diversified medical security system.The application of demand-type policy tools is less on the whole,so we should improve the application of such policy tools and improve the referral policy in medical insurance.The application of environmental policy tools,such as regulation and assessment,is not enough.We should improve the legal construction of the whole medical insurance system and improve the assessment.