随着医保支付方式改革和医保数字化建设的深入推进,医保数据在推动医疗机构高质量发展中的价值日益凸显。本研究基于信息不对称和协同治理理论,通过对武汉市政策实践与两家典型医院的案例剖析,系统探讨了医保数据赋能的实践路径与内在机理。研究发现,医保数据通过驱动管理转型、优化绩效考核与促进临床合理化,有效推动了医疗机构向精细化、高质量发展。然而,数据质量壁垒、机构间应用能力不均衡以及协同机制不完善等问题,制约了赋能效果的深度与广度。据此,本文提出了构建数据全生命周期管理、深化数智应用与完善协同生态等针对性建议。

With the deepening of the medical insurance payment method reform and the medical insurance digitalization construction, the value of medical insurance data in promoting high-quality development of medical institutions is increasingly prominent. Based on the theories of information asymmetry and collaborative governance, this study systematically explores the practical path and internal mechanism of medical insurance data empowerment through the analysis of policy and practice in Wuhan City and cases of two typical hospitals. Research has found that medical insurance data effectively promotes the refinement and high-quality development of medical institutions by driving management transformation, optimizing performance evaluation, and promoting clinical rationalization. However, issues such as data quality barriers, uneven application capabilities among institutions, and imperfect collaboration mechanisms have constrained the depth and breadth of empowerment effects. Therefore, this article proposes targeted suggestions such as building lifecycle management of data, deepening application of digital intelligence, and improving collaborative ecosystems.