慈善医疗是社会力量运用社会资源为社会成员提供医疗保障,以恢复和维持其健康的一种社会制度,是多层次医保制度的有机组成部分。慈善医疗对我国多层次医保制度的影响包括提升多层次医保制度托底保障水平的直接效应、推动多层次医保制度体系完善的间接效应及促进社会主体团结互助的扩散效应三个方面。本文采用“主体–资源–机制–现实影响”的分析框架,从费用补偿、服务供给、共享合作、协商反馈和融合机制五个维度,分析救助者、组织者、受助者三类主体运用经济资源、信息资源、组织资源、技术资源和道德资源实现影响的作用机制。慈善医疗在发挥积极作用的同时,面临费用补偿结构失衡、服务供给边界模糊、共享合作存在障碍、行为失范导致融合失灵等问题。为促进慈善医疗更好发挥作用,应当更新理念,凝聚共识,确保机制行稳致远;出台政策,优化资源配置,推动慈善供需精准对接;优化技术,提高服务效率,保障机制运行顺畅。

Charitable healthcare is a social system that utilizes social resources to provide healthcare security for members of society, restoring and maintaining their health. It is an organic component of multilayer healthcare security system. The impact of charitable healthcare on China's multilayer healthcare security system includes three aspects: direct impact of enhancing the foundational security level of the healthcare security system, the indirect effect of promoting the improvement of this system, and the diffusion effect of fostering solidarity and mutual assistance among social entities. This article adopts an analytical approach of "subject-resource-mechanism-impact, and focuses on five aspects of cost compensation, service provision, collaborative sharing, negotiation and feedback, and integration mechanisms, examining how three types of participants—donors, organizers, and recipients—utilize economical resources, information resources, organizational resources, technological resources, and moral resources. While charitable healthcare plays a positive role, it also faces several challenges, including imbalance in cost compensation structure, vague boundaries in service provision, barriers to collaborative sharing, and behavioral irregularities leading to integration failures. To enhance the effectiveness of charitable healthcare, it is essential to update concepts and build consensus, ensuring that the mechanisms operate on the right track; to introduce polices and optimize resource allocation, promoting precise alignment of charitable resources with needs; and to optimize technology and improve service efficiency, ensuring the smooth operation of the mechanisms.