在我国医疗保障全民覆盖与“全国统一医保信息平台”全面建成的新阶段,数据质量与跨域协同成为管理提质增效的关键。区块链技术以其“不可篡改、可追溯、分布式共识”的特性,可作为可信数据基础设施,为医保管理的流程优化与系统升级提供支撑。本研究认为,区块链在医保管理中的价值演进遵循“数据可信–流程优化–组织协同–生态共治”的路径。现阶段,采用联盟链架构最具可行性,但需攻克跨链互操作、隐私计算等核心瓶颈。其基础应用场景是构建全国统一的“医保一本账”（一人一档、一企一档）,并在此基础上支撑跨省业务协同、省级统筹推进、智能结算对账等高阶应用。未来,通过与大数据、AI融合,可形成“可信数据湖+智能合约”的医保智能体,实现业务闭环管理。本文最终提出“制度引领–标准先行–场景驱动–生态共建”的实施路径,并就数据权属、智能合约效力、跨链监管与人才培养提出建议,旨在为医保管理数字化转型与高质量发展提供理论和技术参考。

In the new stage of achieving universal healthcare coverage and the full completion of the "National Unified Healthcare Information Platform" in China, data quality and cross-domain collaboration have become crucial for improving management efficiency and effectiveness. Blockchain technology, with its characteristics of "immutability, traceability, and distributed consensus", can serve as a trusted data infrastructure, supporting process optimization and system upgrades in healthcare security management. This study posits that the value evolution of blockchain in healthcare security management follows the pathway of "data credibility - process optimization - organizational collaboration - ecosystem co-governance". At the current stage, adopting a consortium blockchain architecture is the most feasible approach, though it requires overcoming core bottlenecks such as cross-chain interoperability and privacy computing. Its foundational application scenario involves constructing a nationally unified "Healthcare Security Master Ledger" (one record per individual, one record per enterprise), which in turn supports advanced applications such as cross-provincial business collaboration, provincial-level coordination, and intelligent settlement and reconciliation. In the future, through integration with big data and AI, a healthcare security intelligent system characterized by a "trusted data lake plus smart contracts" can be formed, enabling closed-loop business management. This paper ultimately proposes an implementation pathway of "system guidance - standards first - scenario-driven - ecosystem co-construction", and offers recommendations on data ownership, the validity of smart contracts, cross-chain supervision, and talent cultivation, aiming to provide theoretical and technical references for the digital transformation and high-quality development of healthcare security management.