整体性治理视域下多层次医疗保障体系的概念厘定、发展困境及路径选择

多层次医疗保障体系内涵不清晰及治理碎片化使医疗保障高质量发展受到挑战。文章以整体性治理理论对多层次医疗保障体系概念内涵进行厘定，从制度的本质属性及直接功能角度区分了托底层、基本层和补充层，并对各层次及其所含子制度间的关系做了阐释。进而从整体性治理视域检视了当下实践，发现碎片化管理思维主导、子制度功能定位不清、政策协同性不足、参与主体单一、平等协商机制缺乏等困境制约着多层次医疗保障体系的整体效能，需要从整体性治理视角采取系统性、针对性改革予以完善。

The conceptual definition, development dilemma, and path selection of a multi-level healthcare security system under the perspective of holistic governance

The unclear connotation and fragmented governance of the multi-tiered medical security system pose challenges to its high-quality development. This article redefines the concept and connotation of the multi-tiered medical security system using holistic governance theory. It distinguishes the bottom layer, basic layer, and supplementary layer from the perspective of the essential attributes and direct functions of each system. Furthermore, from the perspective of holistic governance, the article analyzes the current reform practice and finds that fragmented management thinking, unclear positioning of sub-system functions, insufficient policy coordination, single participation subject, and lack of equal negotiation mechanisms are constraints on the overall effectiveness of the multi-tiered medical security system. Therefore, it is necessary to adopt systematic and targeted reform measures from the perspective of holistic governance to improve the system.