目的: 深入研究基本医保省级统筹风险调剂制度背后的逻辑,全面剖析该制度的优势、潜在风险与实施路径,为省级统筹的稳步推进提供支持与决策参考。方法: 以贵州为例,通过PEST分析法,从政治、经济、社会、技术4个维度进行分析。结果: 现阶段全省经济运行回升向好,医保参保率稳定在95%以上,但仍存在基本医保筹资难度加大、住院率高、各市州待遇水平差异大等问题。结论: 建议把“统一待遇”作为核心任务、把人口结构优化作为重要目标、把“三医联动”作为关键保障、把“统收统支”作为最终目标,着力解决医保领域发展不平衡不充分的问题,从而促进省级统筹风险调剂制度的健康可持续发展,进一步织密扎牢民生保障的安全网。

Objective: The paper conducts in-depth research on the logic of the provincial-level overall planning risk adjustment system for basic medical insurance, comprehensively analyzes the advantages, potential risks, and implementation paths of this system, and provides support and decision-making references for the steady progress of provincial-level overall planning. Methods: Taking Guizhou Province as an example, the paper analyzes from dimensions of politics, economy, society, and technology with PEST analysis. Results: At present, the economic operation of the whole province is recovering and improving, and the basic medical insurance participation rate is stable at over 95%. However, there are still problems such as increased difficulty in raising basic medical insurance funds, high hospitalization rates, and significant differences in benefits among cities. Conclusion: It is recommended to take "unified benefits" as the core task, optimization of the population structure as an important goal, "coordinated development and regulation of medical insurance, medical services, and pharmaceuticals" as the key guarantee, and "unified financing and expenditure" as the ultimate goal, and focus on solving the problem of unbalanced and insufficient development in the medical insurance field, so as to promote the healthy and sustainable development of the provincial-level overall planning risk adjustment system, and strengthen the safety net of people's livelihood security.