对基本医疗保险支付改革与医疗联合体建设的利益相关性研究

政策的制定和实施与各方利益相关者利益紧密相关,政策改革必然导致各方利益再分配,从而影响改革进程。文章从利益相关者角度出发,探讨近年我国医药卫生体制改革过程中基本医疗保险支付方式改革与医疗联合体建设的利益相关性,分析出两者有5类共同利益相关,并且通过医疗保险支付方式改革中的按人头打包支付等复合支付方式、结合分级诊疗和家庭医生签约服务制度、健全医疗联合体内协商谈判机制这三项政策支持了医疗联合体建设。但仍有待改善之处,需要继续推进医保政策改革,以打包支付积极推动紧密型医疗联合体的构建,发挥并强化信息技术的支撑作用,从而更有利于推动医疗保险支付方式改革和医疗联合体建设。

Relevance of interests between basic medical insurance payment reform and construction of medical consortium

Policy formulation and implementation is closely related to the interests of all stakeholders.Policy reform will inevitably lead to the redistribution of interests among all parties,thus affecting the reform process.From the perspective of stakeholders,this article discusses the five common interests between the basic medical insurance payment model and the construction of medical consortium during health care reform in China.New policies in medical insurance payment model including the combined payment methods(e.g.,package payment per capita),hierarchical diagnosis and treatment,family doctor contracting service,and improved negotiation mechanism within the medical consortium have promoted the construction of medical consortium.However,further reform on medical insurance policies is required.Package payment model may be adopted to actively promote the construction of the medical consortium and to strengthen the supporting role of information technology,so as to promote the reform of medical insurance payment methods and the construction of medical consortium.