摘要
县域医共体建设是新医改"强基层"战略的新探索,旨在通过推动县级医院与基层医疗卫生机构的一体化,强化基本卫生保健体系的服务能力。然而,单靠行政力量推动,医共体并不能成为真正的"利益共同体"。本文基于对浙江省11个医共体建设试点县的实地调查发现,医保支付制度改革是医共体建设成败的重要影响因素之一。唯有真正落实以打包付费为特征的各项医保支付改革,让行政、市场和社群机制发挥协同作用,才能重构适当的医共体激励结构,实现基本卫生保健体系公共治理的创新。
Building County Health Service Communities is a new exploration in implementing the strategy of "enhancing grassroots" in new health reforms,so as to upgrade the service capacities of primary care system by integrating county-level hospitals and a variety of health service centers at the grassroots. Yet,solely relying upon the administrative forces,county health service communities cannot integrated into communities of common interests. Based on field works in 11 pilot counties in Zhejiang,we find that provider payment reforms cast significant impacts upon the success or failure of building county health service communities. Only when a series of provider payment reforms characteristic of "bounded charge" take place and bureaucratic,market,and community mechanisms function in synergistic way,can the appropriate incentive structure take in shape in county health service communities,and public governance innovation for primary care system be achieved.
作者
徐烨云
郁建兴
Xu Yeyun;Yu Jianxing(School of Public Affairs and Dean of Academy of Social Governance,Zhejiang University,Hangzhou 310058)
出处
《中国行政管理》
CSSCI
北大核心
2020年第4期102-108,共7页
Chinese Public Administration
基金
国家自然科学基金重点招标项目“提升基层医疗卫生服务能力研究”(编号:71734005)
浙江省自然科学基金重大项目“基层医疗卫生机构综合运行机制研究”(编号:D19G030003)
关键词
医共体
医保支付改革
基本卫生保健
公共治理创新
激励机制
health service communities
provider payment reforms
primary care
public governance innovation
incentive structure
