目的: 探究将定点零售药店纳入基本医保门诊统筹政策的实施动力及影响因素,并有针对性地提出对策建议。方法: 对我国东、中、西部三个省份省会城市的医保部门决策者、医院管理者和一线门诊医生、药店经营者和工作人员以及职工医保参保人进行半结构化访谈,运用利益相关者理论对各方在政策响应过程中的利益关联程度、政策影响力及执行意愿进行分析。通过构建核心变量矩阵识别并分析政策实施过程中的主要动力及影响因素。结果: 研究发现,各利益相关者与政策的关联程度普遍较强,医保部门在政策制定和推动方面具有显著的影响力,并表现出积极的实施意愿。医院管理者和零售药店经营者也展现出较强的执行意愿,但一线门诊医生和药店员工的积极性相对较低。参保患者对政策的态度在不同地区存在差异,但随着政策的深入实施,参保人对政策的认同感会普遍增强。结论: 为确保政策顺利实施,医保部门可加强技术支持和监管保障,医院管理者和药店经营者应提升管理水平,提高员工的积极性。同时,各方应加强政策宣传教育,尤其需要加大政策实施成效宣传,确保患者能够充分理解政策的好处,进一步提升参保人对门诊共济保障政策的认同感。
Abstract
Objective: The paper explores the motivations and influencing factors in the implementation of integrating retail pharmacies into basic medical insurance outpatient pooling fund policy, the attitudes of various stakeholders towards the policy, and put forwards targeted suggestions to promote the policy smoothly. Methods: Semi-structured interviews were conducted with the decision-makers of healthcare security departments, managers of medical institution and outpatient doctors, retail pharmacy managers and staff, and employees' basic medical insurance participants in the capital cities of three provinces in eastern, central and western regions of China. The stakeholders theory was used to analyze three core variables: the degree of interest correlation, the influence of policies, and the willingness to implement policies, and the core-variable matrix was further used to identify the motivations and influencing factors during the policy implementation. Results: All stakeholders have a strong interest correlation with the policy, and the healthcare security departments have a strong influence in policy and hopes to actively promote the implementation of the policy. The managers of hospitals and retail pharmacies have a strong willingness to implement the policy, but outpatient doctors and pharmacy staff are less motivated. Patients' attitudes towards the policy vary in different regions, but with the implementation of policies, the willingness of the insured people to implement policies will generally increase. Conclusion: The healthcare security departments need to provide strong technical support and supervision. The managers of medical institutions and retail pharmacies need to improve the management mode to enhance the professional competence and motivations of employees. Meanwhile, the publicity of the policy, especially the effectiveness of the policy should be strengthened to ensure that the insured people can fully understand the benefits of the policy, and implement the outpatient mutual aid policies.
关键词
定点零售药店 /
门诊统筹 /
医保政策 /
利益相关者 /
动力分析
Key words
retail pharmacies /
outpatient pooling /
medical insurance policy /
stakeholders /
motivation analysis
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] CHEN Y, GAO G, YUAN F, et al.The impact of medical financial assistance on healthcare expenses and the medical financial burden: evidence from rural China[J].Frontiers in public health, 2022, 10(1021435).
[2] 李娜,胡敏,陈文,等.城镇职工基本医疗保险个人账户改革现状及机制分析[J].中国卫生经济,2019,38(10):30-33.
[3] 国家医疗保障局.2021年全国医疗保障事业发展统计公报[EB/OL].(2022-06-08)[2023-12-06].http://www.nhsa.gov.cn/art/2022/6/8/art_7_8276.html?eqid=d4fa78af0003179d000000036433b153.
[4] 国务院.国务院办公厅关于建立健全职工基本医疗保险门诊共济保障机制的指导意见[EB/OL].(2021-04-22)[2023-12-06].https://www.gov.cn/zhengce/zhengceku/2021-04/22/content_5601280.htm.
[5] 杨华磊,曹顺子,郝杰.职工医保统筹基金的财政压力研究——基于门诊共济改革政策的分析[J].中国医疗保险,2023(11):41-48.
[6] 国务院.国家医保局:支持定点零售药店开通门诊统筹服务[EB/OL].(2023-02-16)[2023-12-06].https://www.gov.cn/fuwu/2023-02/16/content_5741659.htm.
[7] 胡婉慈,杨钰婷,左根永.我国零售药店纳入门诊统筹报销政策的省际比较[J].中国卫生政策研究,2023,16(10):56-63.
[8] 国务院.全国超14万家定点零售药店开通门诊统筹报销服务[EB/OL].(2023-09-22)[2023-12-06].https://www.gov.cn/lianbo/bumen/202309/content_6905683.htm.
[9] 吴敏,韩志琰,穆晓敏,等.政策工具视角下我国基本医保门诊保障政策文本分析[J].中国医疗保险,2023(08):28-35.
[10] FRANCO TRIGO L, FERNANDEZ LLIMOS F, MARTINEZ MARTINEZ F, et al.Stakeholder analysis in health innovation planning processes: a systematic scoping review[J].Health policy, 2020, 124(10): 1083-1099.
[11] 徐一华,陈春,王涛,等.利益相关者视角下的区域医疗联合体利弊分析[J].医学与哲学, 2015,36(12):79-81.
[12] 王清波,胡佳,代涛.建立分级诊疗制度的动力与阻力分析——基于利益相关者理论[J].中国卫生政策研究,2016,9(04):9-15.
[13] 王尧,秦廷廷,谷明宇,等.基于半结构化访谈法的卫生体系视角下我国基层高血压管理模式的实施现状、问题分析及政策建议[J].中国全科医学,2024,27(13):1544-1549.
[14] 田勇,殷俊,薛惠元.城镇职工医疗保险个人账户改革方案设计与评估[J].经济管理,2018,40(09):173-188.
[15] YIP W, FU H, CHEN A T, et al.10 years of health-care reform in China: progress and gaps in universal health coverage[J].Lancet, 2019, 394(10204): 1192-1204.
[16] 马国善.职工医保门诊共济保障机制与思考——以山东省济宁市为例[J].中国医疗保险,2022(08):81-84.
[17] 薛原,杨令.“互联网+”背景下网上药店市场经营现状与监管对策探讨[J].中国卫生事业管理,2020,37(05):376-379.
[18] 陈利芳,骆婷,罗创军.绩效管理在医院药学管理工作中的应用价值探究——以中山市某医院为例[J].中国医疗保险,2022(04):69-71.
[19] 张维超,付海龙,韩煦.建立健全职工基本医保门诊共济保障机制的思考[J].中国医疗保险,2022(05):57-59.
[20] 张磊,武若瑜,陈非非,等.我国职工医保门诊共济保障改革的进展与思考[J].中国卫生经济,2023,42(10):10-13.
基金
国家社会科学基金重大项目“乡村振兴战略下县域医共体向健共体转型机制研究”（22&ZD143）
