我国医疗服务价格调整与医保支付方式改革的联动机制研究

相较于医药医保、医药医疗间关系的渐趋合理,医保与医疗间协调互动关系仍亟待深入讨论。医疗服务价格动态调整和医保支付方式优化分别是针对供给方和购买方的重要改革思路,两方面改革均有助于提升医疗体系改革成效,本文基于发挥政策合力提升社会福利水平的研究目标分析了如何建立二者的联动机制。主要研究结论是,应遵循激励相容的改革原则,以改善医疗机构行为作为联动机制的关键政策节点,通过构建互动嵌套的优化机制发挥政策合力。此外,联动机制的良好运转也需外部协同治理。建议应推行健康管理促进居民生活方式科学化、推进医联体建设提高优质医疗资源共享水平以及推动互联网与医疗服务的进一步产业融合化。

Research on the linkage mechanism between the adjustment of medical service price and the reform of medical insurance payment mode in China

The relationship between medicine and medical insurance is becoming increasingly reasonable, and the same happens with the relationship between medicine and medical treatment. However, the coordination and interaction between health insurance and healthcare still needs to be further discussed. The dynamic adjustment mechanism of medical service price and optimization of medical insurance payment mode are important reform policies for suppliers and buyers, respectively. Both policies are helpful to the enhancement of the effectiveness of medical system reform. Based on the research goal of promoting social welfare, this paper analyzed the internal logic relationship between the two, and exploring the practical path of the reform linkage mechanism under this logical framework. Conclusively, this study points out that the linkage mechanism between the dynamic adjustment of medical service price and the reform of medical insurance payment mode should be constructed following the reform principle of incentive compatibility. During this process, improving the behavior of medical institutions is the key policy node of the linkage mechanism, and policy synergy should be exerted by building an optimized, interacted and nested mechanism. In addition, the good operation of the linkage mechanism also needs external collaborative governance. It is suggested that health management should be rationally carried out to promote healthy lifestyle of residents, promote the establishment of integrated healthcare system as a means ofimproving the sharing level of high quality medical resources, and enhancethe industrial integration of Internet and medical services.