数字经济时代为医保治理提供了新的价值创造和价值分配手段,数据信息的无限性、算法处理的创新性和算力支撑的网络化使得共建共治共享的医保治理新格局成为现实。本文利用“主体—资源—内容”的整合式分析框架,从顶层设计、管理机制、服务机制、递送机制、监督机制和协商机制六个维度出发,强调治理主体和治理资源的融合和共享,梳理医保制度体系完善、医保经办管理优化、医保服务供需平衡和医保应用场景拓展等治理内容。数字经济为医保治理带来数字红利的同时,也出现数字创新可扩展性受限、医保治理体系脆弱性和服务供给结构性失衡等问题。对此,本文提出通过医保业务一体化经办、医保服务平台化集成、医保产品智能化应用、医保基金数字化监管和医保主体网络化联动等推动医保治理机制创新,有助于实现医保共治的结构化集成和动态化应用。同时,可以从数字健康嵌入服务场景、数字红利赋能制度效率、数字智慧助推管理经办和数字立法引领政策监管等方面实现数字经济时代医保治理的政策优化。

The era of digital economy provides new means of value creation and value distribution for medical insurance governance. The unlimited nature of data information, the innovativeness of algorithm processing, and the networking supported by computing power makes the new pattern of medical insurance governance of joint construction, joint governance, and sharing a reality. This article uses the integrated analysis framework of “subject-resource-content” and emphasizes the integration and sharing of governance subjects and governance resources from the six dimensions of top-level design, management mechanism, service mechanism, delivery mechanism, supervision mechanism and consultation mechanism. It clarifies the governance contents such as the improvement of the medical insurance system, the optimization of medical insurance management, the balance between supply and demand of medical insurance services, and the expansion of medical insurance application scenarios. While the digital economy brings digital dividends to medical insurance governance, it also presents problems such as limited scalability of digital innovation, fragility of the medical insurance governance system, and structural imbalances in the service supply. Accordingly, this article believes that promoting the mechanism innovation of medical insurance governance through integrated management of medical insurance business, integration of medical insurance service platforms, intelligent application of medical insurance products, digital supervision of medical insurance funds, and network linkage of medical insurance entities, which can help to achieve structured integration and dynamic application of medical insurance joint governance. At the same time, policy optimization of medical insurance governance in the digital economy era can be achieved from aspects such as digital health-embedded service scenarios, digital dividend-empowered system efficiency, digital wisdom boosting management, and digital legislation leading policies and supervisions.