多层次医疗保障体系是随着我国医疗保障制度的改革完善逐步建构形成的,这一过程同时也映射出政府与市场关系的不断调整,政府公共服务能力的逐步提升。结合多层次医疗保障体系制度变迁与学界观点,本文将多层次医疗保障体系分为托底层、基础层、补充层、拓展层和公益层。根据协同治理理论构建三维分析框架,从治理主体、协同关系和治理工具探寻多层次医疗保障的治理之道。多元主体参与拓宽了协同治理的宽度,政府嵌入和引导是必要的,各主体协同关系反映治理的深度,平衡稳定的协同治理关系需要充分考虑各方利益诉求。治理工具上更多运用激励性、沟通性、契约性等混合工具,重视程序性治理工具的作用,把握好治理力度,逐渐规范协同治理过程。

Multi-level medical security system is gradually formed with the reform and perfection of the medical security system in China. This process not only reflects the constant adjustment of the relationship between the government and market, but also the gradual improvement of the government’s public service capability. Combined with the institutional changes of the multi-level medical security system and the academic view, this paper divides the multi-level medical security system into the basic layer, the foundation layer, the supplementary layer, the expansion layer and the public benefit layer. According to the theory of collaborative governance, a three-dimensional analysis framework is constructed to explore the governance of multi-level medical security from the governance subject, collaborative relationship and governance tools. The participation of multiple entities has broadened the width of collaborative governance, and it is necessary for the government to embed and guide it. The collaborative relationship between various entities reflects the depth of governance, and a balanced and stable collaborative governance relationship needs to fully consider the interests and demands of all parties. In terms of governance tools, the government should use mixed tools such as incentives, communications and contracts, attach importance to the role of procedural governance tools, make good use of governance, and gradually standardize the collaborative governance process.