我国医保监管的历史进路、演变逻辑和未来展望——基于历史制度主义的分析

本研究基于建国以来医保监管政策文本的分析，将我国医保监管分为分散自主监管期、初步集中监管期、整合探索监管期和集中多元监管期四个阶段，并从监管主体、监管内容和监管方式三个层面对各阶段的监管特征进行了总结。在此基础上，运用历史制度主义理论审视医保监管变迁过程，发现宏观制度变革、政治变量更新和政府职能转变为医保监管变迁提供了结构性动力，而路径依赖和关键节点在医保监管变迁的历史性维度中扮演了重要角色。未来我国医保监管应当提高监管机构独立性、培养风险监管和服务监管理念、强化协同监管机制，并着力打造智慧医保监管。

The historical path, evolution logic and future prospect of China's medical security supervision: Based on the analysis of historical institutionalism

Based on the analysis of China''s medical security supervision policy texts since the founding of People''s Republic of China, this work divides the evolution of our medical security supervision policy into four periods: the decentralized and independent supervision period, the initial centralized supervision period, the integrated exploration supervision period and the centralized diversified supervision period. Furthermore, this paper summarizes the characteristics of each stage of supervision from three levels: subject, content and mode of supervision. On this basis, historical institutionalism theory is used to examine the evolution process of medical security supervision. It is found that macroscopic policy changes, the renewal of political variables and the transition of government functions provide structural motivation for the evolution of medical security supervision, and path dependence and key nodes play an important role in the historical dimension of the evolution of medical security supervision. In the future, it is suggested that China''s medical security supervision should improve the independence of supervising agencies, emphasize the concept of risk supervision and service supervision, strengthen the collaborative supervision mechanism, and strive to build intelligent medical security supervision.