摘要
目的: 本研究旨在构建“政策统一、基金安全、系统协同、治理转型”四维框架,系统阐释基本医疗保险省级统筹的核心内涵、路径与影响。方法: 通过政策文本与多省案例比较分析,深入剖析省级统筹的实施路径及成效。结果: 省级统筹是以“统一政策、调剂金制度、预算管理、经办服务”为支柱的制度重构,遵循“基金调剂先行、支付改革牵引、数据治理赋能、分级诊疗协同”的渐进路径。此举显著增强了制度公平与基金抗风险能力,推动了“三医”联动与治理现代化,但也需警惕可能加剧资源虹吸等风险。结论: 改革成功的关键在于同步深化系统协同、夯实基层服务网底并完成治理体系全面跃迁,未来应向“统收统支”深化,强化数据驱动治理,筑牢全民医保制度的基石。
Abstract
Objective: This study aims to construct a four-dimensional framework encompassing policy unification, fund security, system synergy, and governance transformation, to systematically elucidate the core essence, pathways, and impacts of provincial pooling in basic medical insurance. Method: Through comparative analysis of policy texts and cases from multiple provinces, we conducted an in-depth analysis of the implementation paths and effectiveness of provincial-level coordination. Results: Provincial pooling is a system reconstruction based on the pillars of unified policy, fund adjustment system, budget management, and operational services, following a gradual path of fund adjustment first, payment reform leading, data governance empowering, and hierarchical diagnosis and treatment collaboration. This measure significantly enhances institutional fairness and fund risk resistance, promotes coordinated development and regulation of medical insurance, medical services, and pharmaceuticals and modernization of governance, However, it is also necessary to guard against potential risks such as the exacerbation of resource siphoning. Conclusion: The key to successful reform lies in simultaneously deepening system collaboration, consolidating the grassroots service network, and completing a comprehensive transition of the governance system. In the future, it should deepen towards unified pooling and allocation, strengthen data-driven governance, and build a solid foundation for the universal medical insurance system.
关键词
省级统筹 /
“三医”联动 /
基金调剂 /
统收统支 /
基本医疗保险
Key words
provincial coordination /
coordinated development and regulation of medical insurance /
medical services /
and pharmaceuticals /
fund adjustment /
unified pooling and allocation /
basic medical insurance
陈邦旋.
迈向公平、安全与协同治理：医保省级统筹的四维路径与系统性影响研究[J]. 中国医疗保险. 2026, 0(1): 53-60 https://doi.org/10.19546/j.issn.1674-3830.2026.1.007
Moving Towards Equity, Safety, and Collaborative Governance: A Four-Dimensional Path and Systemic Impact Study on Provincial-Level Coordination of Basic Medical Insurance[J]. China Health Insurance. 2026, 0(1): 53-60 https://doi.org/10.19546/j.issn.1674-3830.2026.1.007
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