摘要
目的: 本研究以公共管理的事权划分理论为基础,探究异地就医管理中不同层级医保部门事权划分和支出责任的关系,以期为推进就医地管理提供参考借鉴。方法: 首先,通过查阅文献探究医疗保险及其他公共管理事权划分和支出责任的研究情况。其次,通过政策文本检索,结合异地就医结算发展现状,辨析基于机构职责的事权划分和基于政策文件的事权划分,明晰事权划分与财政支出的匹配性等情况。结果: 基于机构职责的事权划分和基于政策文件的事权划分有偏差,财政支出管理现状不能满足强化异地就医的就医地管理需要。建议：明确省级和地市级医保部门就医地管理的机构职责,增强跨省异地就医管理的中央事权,强化专项转移支付对异地就医管理的绩效考核,用政策事权划分及协同补齐部分异地就医管理短板。
Abstract
Objective: Based on the theory of power division of authority in public management, this study explores the relationship between the power division of authority and expenditure responsibility of healthcare security departments at different levels in the management of off-site medical treatment, in order to provide a reference for promoting the management of medical treatment locations. Methods: Firstly, the literature was reviewed to explore the research on the power division of authority and expenditure responsibility of medical insurance and other public administrations. Secondly, through the retrieval of policy texts and the development status of off-site medical treatment settlement, the power division of authority based on institutional responsibilities and the power division of authority based on policy documents were analyzed, and the matching between the power division of authority and fiscal expenditure was clarified. Results: There is a deviation between the power division of authority based on institutional responsibilities and the power division of authority based on policy documents, and the current situation of fiscal expenditure management cannot meet the needs of strengthening the management of medical treatment in other places. Suggestions: We should clarify the institutional responsibilities of the provincial and municipal healthcare security departments for the management of medical treatment locations, strengthen the central authority of cross-provincial medical treatment management, enhance the performance evaluation of special transfer payments for off-site medical treatment management, and use policy power division and coordination to make up for shortcomings in off-site medical treatment management.
关键词
异地就医 /
事权划分 /
支出责任
Key words
off-site medical treatment /
division of powers /
expenditure responsibility
屈海龙, 郑艺, 张立强, 田然, 杨睿.
异地就医管理中医保事权划分及支出责任探究[J]. 中国医疗保险. 2024, 0(6): 29-36 https://doi.org/10.19546/j.issn.1674-3830.2024.6.004
Exploration of the Power Division and Expenditure Responsibility of Healthcare Security Authority in the Management of Off-Site Medical Treatment[J]. China Health Insurance. 2024, 0(6): 29-36 https://doi.org/10.19546/j.issn.1674-3830.2024.6.004
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 国家统计局.第七次全国人口普查公报[R/OL].(2021-05-11)[2024-05-10].https://www.gov.cn/guoqing/2021-05/13/content_5606149.htm.
[2] 国家医疗保障局.全国医疗保障跨省异地就医直接结算公共服务信息发布(第五十九期)[EB/OL]..(2024-01-29)[2024-05-10].http://www.nhsa.gov.cn/art/2024/1/29/art_114_12032.html.
[3] 白景明,朱长才,叶翠青,等.建立事权与支出责任相适应财税制度操作层面研究[J].经济研究参考,2015(43):3-91.
[4] 李齐云.建立健全与事权相匹配的财税体制研究[M].北京:中国财政经济出版社,2013.
[5] 孙开.论公共产品的层次性与政府间的财政关系[J].财经问题研究,1994(09):41-44.
[6] 刘尚希,石英华,武靖州.公共风险视角下中央与地方财政事权划分研究[J].改革,2018(08):15-24.
[7] 王湘军,李雪茹.深化政府事权划分改革之整体框架建构[J].中国行政管理,2019(04):32-37.
[8] 楼继伟.深化事权与支出责任改革——推进国家治理体系和治理能力现代化[J].财政研究,2018(01):2-9.
[9] 财政科研协作课题组.加快构建事权与支出责任相适应的财政体制——基于山东、吉林、焦作、龙岩的分析与思考[J].公共财政研究,2015(2):24-52.
[10] 贾康,苏京春.现阶段我国中央与地方事权划分改革研究[J].财经问题研究,2016(10):71-77.
[11] 祝沁磊.基本医疗保险事权与支出责任研究[D].上海:上海财经大学,2021.
[12] 国家医保局,财政部.关于进一步做好基本医疗保险跨省异地就医直接结算工作的通知[Z/OL].(2022-07-26)[2024-05-10].http://www.nhsa.gov.cn/art/2022/7/26/art_104_8629.html.
[13] 吉林省医保局.关于印发《吉林省医疗保险异地就医经办规程》的通知[Z/OL].(2023-08-14)[2024-05-10].https://xxgk.jl.gov.cn/zsjg/fgw/xxgkmlqy/202308/t20230814_8780571.html.
[14] 湖南省医保局.关于印发湖南省基本医疗保险异地就医直接结算管理办法(试行)的通知[Z/OL].(2023-02-03)[2024-05-10].https://www.junshan.gov.cn/32415/32465/62024/62028/content_2032767.html.
[15] 国家医疗保障局.医疗保障行政处罚程序暂行规定[Z/OL].(2021-06-11)[2024-05-10].https://www.gov.cn/gongbao/content/2021/content_5637952.htm.
[16] 周天勇,谷成.中国收入分配:探究与争论专题三未来财政税收体制改革的方案设计第四章理顺中央与地方的财税关系[C]//中国经济体制改革研究会,北京师范大学.中国收入分配:探究与争论.北京:中国经济出版社,2010:15.
[17] 财政部.中央对地方专项转移支付绩效目标管理暂行办法[Z/OL].(2015-11-06)[2024-05-10].https://www.gov.cn/xinwen/2015-11/06/content_2961579.htm.
