在国家政务服务标准化、规范化、便利化及医疗保障领域“放管服”改革纵深推进的时代背景下,县域医保经办窗口作为面向群众落实医保待遇、解读医保政策、处置民生诉求的核心公共服务载体,其人力资源效能的高低,在相当程度上决定了公共服务供给质量与政府部门的公信力。人力资源作为医保窗口提质增效的核心生产要素,其中队伍综合素养、岗位适配水平、配套管理机制,共同构成制约窗口经办效能释放的关键变量。本文以淮安市多个县区医保经办窗口为考察对象,开展实证调研。现阶段基层医保窗口普遍存在人员身份结构失衡、考核机制固化、激励方式单一、培训体系针对性不足、人才留存机制不完善、管理机制薄弱等现实约束,人力资本价值未能得到充分激活。本研究以人力资本理论、公平理论及目标管理理论为分析框架,系统梳理县区医保窗口人力资源管理的运行现状,精准识别其在效能建设中存在的多维短板,并深入剖析其背后制度设计、管理理念及资源保障层面的深层诱因。在此基础上,研究构建了一个涵盖“人岗动态适配、分层分类考核、多维立体激励、阶梯式培训开发、全周期人才保留及数字化管理赋能”的闭环式效能提升策略体系。研究结论旨在为优化县区医保窗口的人力资源配置模式、缓解一线经办人员的职业倦怠、激活从业人员的内生动力并提供本土化的理论参考与实践方案,从而为夯实基层医疗保障公共服务高质量发展的人才基础提供支撑。

Against the backdrop of the nationwide advancement of standardized, normalized, and convenient administrative services, coupled with the deepening of the "streamlining administration, delegating power, and optimizing services" reforms in the healthcare security sector, county-level medical insurance service windows serve as the core public service platforms through which the public receives medical insurance benefits, interprets medical insurance policies, and addresses livelihood-related appeals. Consequently, the efficiency of their human resources largely determines the quality of public service delivery and the credibility of government departments. As the core production factor for enhancing the quality and efficiency of these windows, human resources—encompassing the overall competence of the workforce, the degree of person-post alignment, and the supporting management mechanisms—jointly constitute the key variables that constrain the release of service efficiency at the windows. Taking the medical insurance service windows of multiple counties and districts in Huai'an City as the subjects of investigation, this study conducts empirical research. At the current stage, grassroots medical insurance windows generally face practical constraints such as an imbalanced personnel identity structure, rigidified assessment mechanisms, monotonous incentive approaches, insufficiently targeted training systems, imperfect talent retention mechanisms, and weak management mechanisms, leaving the value of human capital insufficiently activated. Within the analytical framework of human capital theory, equity theory, and management by objectives theory, this study systematically reviews the operational status of human resource management in county-level medical insurance windows, precisely identifies the multidimensional shortcomings in their efficiency-building efforts, and conducts an in-depth analysis of the underlying causes at the levels of institutional design, management philosophy, and resource guarantees. On this basis, the study constructs a closed-loop efficiency enhancement strategy system encompassing "dynamic person-post adaptation, tiered and categorized assessment, multidimensional and multi-faceted incentives, laddered training and development, full-cycle talent retention, and digital management empowerment". The findings are intended to provide localized theoretical references and practical solutions for optimizing the human resource allocation model of county-level medical insurance windows, alleviating the occupational burnout of frontline service personnel, and activating the intrinsic motivation of practitioners, thereby reinforcing the talent foundation for the high-quality development of grassroots healthcare security public services.