为促进互联网医保支付建设更加满足居民多元化的就医报销需求,本研究系统整理了“互联网+医疗”背景下医保支付的内在机遇和潜在挑战。通过对当下互联网时代医保支付情况进行分析,发现互联网医疗的发展和群众需求增长等可为互联网医保支付体系建设注入源源不断的新动能,但在其建设初期也存在政策和监管滞后、基金风险加剧等挑战。基于以上分析,建议医保相关部门结合实际完善政策与监管、多维度加强线上资金管理、引入新技术保障互联网医保支付体系有序运行并维护患者隐私安全、满足群众多元性需求等,以构建更加公平有序、高效便捷、普惠且可持续的互联网医保支付体系。

In order to promote the construction of Internet-based medical insurance payment to better meet the diverse reimbursement needs of residents, this study systematically summarizes the inherent opportunities and potential challenges of medical insurance payment in the context of "Internet plus healthcare". By analyzing the current situation of medical insurance payment in the era of the Internet, the continuous infusion of new momentum into the construction of the Internet-based medical insurance payment system has been driven by the development of Internet healthcare and the growing demand of the public. However, there are also challenges such as lagging policies and regulations, increased fund risks during the initial stages of construction. Based on the analysis above, it is suggested to improve policies and regulations in conjunction with reality, strengthen online fund management from multiple dimensions, introduce new technologies to ensure the orderly operation of the Internet-based medical insurance system while safeguarding patients’ privacy, and meet the diverse needs of the public to build a fair, orderly, efficient, convenient, inclusive, and sustainable online medical insurance payment system.