目的: 从医保治理现代化视角,探讨国家与省际联盟药品集采在金融支持机制上的分层治理路径与协同机制。方法: 基于治理体系现代化与协同治理理论,结合交易成本与制度经济学分析方法,系统阐释集采与金融工具协同的理论逻辑,分析国家与省级层面在金融需求、风险属性与治理工具上的差异。结果: 集采进入常态化阶段后,全国性金融基础设施建设、区域性风险分担机制设计及跨部门政策协同等方面仍存在精细化提升空间。传统行政手段难以满足中选企业融资与供应保障的结构性需求。量化分析显示,国家集采中选企业平均融资需求约为省际联盟企业的6~7倍（加权平均口径）,融资成本差异较为显著（200~300个基点）,省级风险补偿基金覆盖范围较为有限。结论: 本研究构建了国家信用信息平台与政策性金融支持相结合、省级风险补偿基金与地方金融协同相补充的双层治理体系,并设计近期、中期、远期分阶段实施路径,以期为药品集采长效运行和医保治理现代化提供理论支撑。

Objective: From the perspective of modernized medical insurance governance, this study explores the hierarchical governance pathways and collaborative mechanisms of financial support in national and inter-provincial alliance drug centralized procurement. Methods: Based on the theories of governance system modernization and collaborative governance, combined with transaction cost and institutional economics analytical approaches, the theoretical logic of centralized procurement and financial instrument synergy is elucidated, while differences in financial needs, risk attributes, and governance tools between the national and provincial levels are analyzed. Results: After centralized procurement enters the normalized stage, there is room for refinement in national financial infrastructure, regional risk-sharing mechanisms, and cross-departmental policy coordination. Traditional administrative measures struggle to meet the financing and supply guarantee needs of selected enterprises. Quantitative analysis reveals that the average financing demand of enterprises selected in national centralized procurement is approximately 6 to 7 times that of inter-provincial alliance enterprises, with significant financing cost disparities (200~300 basis points). Provincial risk compensation funds exhibit relatively limited coverage. Conclusion: The study establishes a dual-layer governance system integrating national credit information platforms with policy-based financial support, supplemented by provincial risk compensation funds and local financial collaboration, while designing phased implementation pathways for the near, medium, and long-term to provide theoretical support for the long-term operation of centralized drug procurement and the modernization of medical insurance governance.