医保基金战略购买:基本概念、国际经验与中国镜鉴

中国特色医保基金战略购买是一个在"前瞻、系统、整体"战略视角指导下,以医保基金为购买主体,医疗服务为购买客体,追求医疗服务体系结构优化、国民健康收益结构优化的动态、循证、优化过程.战略购买在欧洲地区的实践效果不佳,本文以NHS英格兰为例对其政策实践和失败原因做了梳理总结,认为其主观上的改革理念彷徨、客观上的供需力量失衡...

Strategic purchasing of medical insurance fund: Basic concepts, international experiences and future practices of China

Strategic purchasing of medical insurance fund with Chinese characteristics is an evidence-based and dynamic optimization process under the guidance of a "forward-looking, systematic and holistic" strategic perspective. In this regard, the medical insurance fund is taken as the main purchaser and the medical service system as the purchase object. This helps to pursue the optimization of the structure of medical service system and the equity distribution of national health benefits. Strategic purchasing in Europe is not effective in practice. Taking National Health Service (NHS) England as a research sample, this paper summarizes its policy practice and draws the reasons for its failure. With the results of the research, it is believed that the subjective uncertainty of the reform concept and the objective power imbalance between the supply and demand sides constitute the main reasons for the failure of strategic purchasing NHS England. Combining international experience and basing on native context of China, the specific contents of strategic purchasing of medical insurance fund with Chinese characteristics is further discussed from five aspects, namely, "who buys, for whom, what to buy, how to buy, and how to pay".