This paper expounds, from theoretical and policy perspectives, the internal logic of the synergy between the construction of close-knit medical consortium and the reform of medical insurance payment models. The typical practice in Sanming City demonstrates that consolidating close-knit medical consortium, implementing global budget prepayment for medical insurance, establishing a diversified and composite payment model centered on capitation, coupled with incentive and constraint policies such as “surplus retained, overspending not compensated” and supporting these with a scientific incentive assessment system, are fundamental pathways and key measures to encourage medical institutions at all levels and of various types within the consortium to return to their functional positioning, standardize diagnosis and treatment behaviors, promote health management, build a system of “prevention, screening, diagnosis, treatment, rehabilitation, and management,” and ultimately achieve safer and more effective utilization of medical insurance funds, more stable and sustainable operation of the medical system, improved health levels of residents, and reduced financial burdens.
Key words
close-knit medical consortium /
reform of medical insurance payment models /
health management
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] 中共中央,国务院.关于深化医疗保障制度改革的意见[Z].2020-02-25.
[2] 国务院办公厅.关于印发《关于加快建设分级诊疗体系的若干措施》的通知:国办发〔2026〕11号[Z].2026-04-06.
[3] 国家医保局,国家发展改革委,国家卫生健康委.关于医保支持基层医疗卫生服务发展的指导意见:医保发〔2026〕7号[Z].2026-03-16.
[4] 刘嵌玥. 三明市委副书记、市长陈岳峰:人民至上敢为人先持续推动三明医改迭代升级[J].中国卫生,2026(5):24.
[5] 吕维纯,李欣,钱嘉琳,等.基于制度变迁理论的三明医改实施机制分析[J].中国卫生事业管理,2026,43(4):361-367.
[6] 张元明.三明:用价格杠杆撬动协同发展[J].中国卫生,2024(7):46-47.
[7] 应亚珍. 三明医改成功转段[J].中国卫生,2016(3):91.
[8] 李珍,蒋浩琛,杨玲.医保战略购买赋能整合型医疗卫生服务体系的激励机制研究——基于三明医改的案例分析[J].社会保障研究,2025(5):29-43.
[9] 应亚珍,李欣芳,曹人元.双重变革:医疗服务体系与医保支付[J].中国医疗保险,2022(6):5-8.
[10] 国家卫生健康委员会.国家卫生健康委员会2024年1月12日新闻发布会文字实录[EB/OL].(2024-01-12)[2026-04-20].https://www.nhc.gov.cn/xcs/c100122/202401/xxxxx.shtml.
[11] 应亚珍.促进医疗医保医药协同发展和治理[EB/OL].(2025-08-04)[2026-04-20].https://www.jingjiribao.cn/static/detail.jsp?id=601649.
[12] 张立强,李欣芳,李响,等.DRG、DIP付费改革下结余留用政策逻辑与思考[J].中国卫生经济,2023,42(5):13-16.
[13] 张元明. 三明市医改与DRG收付费改革的经验总结[J].中国卫生经济,2022,41(1):16-19.
[14] 国家卫生健康委办公厅,国家医保局办公室,国家中医药局综合司,等.关于印发紧密型县域医疗卫生共同体监测指标体系的通知:国卫办基层发〔2024〕22号[Z].2024-10-30.
[15] 廖冬平. 三明县域健康管理的实践探索[J].中国卫生,2021(8):74-75.
[16] 国家医疗保障局.国家医保局局长章轲等出席国务院新闻办公室新闻发布会介绍“十四五”时期深化医保改革,服务经济社会发展有关情况[EB/OL].(2025-07-24)[2026-04-20].https://www.nhsa.gov.cn/art/2025/7/24/art_14_17369.html.
[17] 胡琦,雷悦.DRG对医疗服务效率的影响 ——基于双重差分模型的实证分析[J].中国医疗保险,2024(10):102-111.
[18] 刘志辉,林妍,孟凡强.医保支付方式改革与医疗卫生服务效能——来自三明医改的证据[J].应用经济学评论,2025,5(1):170-187.
