Direct settlement between medical insurance funds and pharmaceutical enterprises is an important measure for deepening the reform of the healthcare security system and improving the closed-loop management of the centralized drug procurement policy. Taking Fuyang City as an example, this study combines policy pilot tracking and observation with empirical analysis to systematically examine the practical pathways, mechanism evolution, and policy outcomes of Fuyang City's direct settlement of medical insurance funds implemented since 2020. Through a three-stage, incremental reform process of “pilot exploration-mechanism optimization-information technology empowerment”, Fuyang City established an institutional evolution pathway of “advance revolving funds-full direct settlement-online intelligent settlement”, which effectively shortened settlement cycles, reduced the cost of capital occupation for pharmaceutical enterprises, and stimulated the implementation of the centralized procurement policy. The practice confirms that the initiative of local governments in institutional innovation, the empowering role of information technology in process reengineering, and the establishment of a multi-stakeholder collaborative governance mechanism are key factors contributing to the success of direct settlement reform.
Key words
direct settlement of medical insurance fund /
national volume-based procurement /
settlement mechanism /
digital governance
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] 国务院办公厅.关于印发国家组织药品集中采购和使用试点方案的通知:国办发〔2019〕2号[EB/OL].(2019-01-01)[2026-06-24].http://www.gov.cn/zhengce/content/2019-01/17/content_5358604.htm.
[2] 中共中央,国务院.关于深化医疗保障制度改革的意见[EB/OL].(2020-02-25)[2026-06-24].http://www.gov.cn/zhengce/2020-03/05/content_5487407.htm.
[3] 李珍,陈晋阳,王红波.医保基金战略购买:基本概念、国际经验与中国镜鉴[J].中国卫生政策研究,2021,14(5):1-7.
[4] 蔡雪妮. 中国药品集中采购的演变以及与医保支付的逻辑关系[J].中国卫生政策研究,2017,10(6):6-12.
[5] 孙长胜,张寒菊.张家口市药品集中采购直接结算的实践探索[J].中国医疗保险,2022(2):66-69.
[6] 国家医疗保障局.医保基金直接结算赋能医药产业高质量发展:[EB/OL].(2024-07-19)[2026-06-24].https://www.nhsa.gov.cn/art/2024/7/19/art_14_13289.html.
[7] 阜阳市医保局.关于印发阜阳市医保基金与医药企业直接结算管理办法(试行)的通知:阜医保发〔2021〕85号[EB/OL].(2021-10-29)[2026-06-24].https://ylbz.fy.gov.cn/Content/show/1340451.html.
[8] 宋佳,范成鑫,王婉晨,等.利益相关者视角下我国药品集中带量采购政策研究——基于政策工具的文本分析[J].中国卫生政策研究,2022,15(2):11-17.
[9] 赵金旭,赵娟,孟天广.数字政府发展的理论框架与评估体系研究——基于31个省级行政单位和101个大中城市的实证分析[J].中国行政管理,2022,(6):49-58.
[10] 唐玉清,李胤铭,陈西卓,等.基于政策执行系统模型的药品集中采购政策执行分析——N省的实践研究[J].中国卫生政策研究,2023,16(9):29-35.
[11] 阜阳日报.全省率先！我市药品结算“云直联”支付[EB/OL].(2022-09-21)[2026-06-24].https://www.fytv.com.cn/mobile/detail-21087.html.
[12] 吴群红,覃英华.医疗保障治理体系和治理能力现代化内涵及其实现路径研究[J].中国医疗保险,2022(5):31-39.
[13] 杨莹,刘雨欣,毛靖,等.药品集中带量采购政策对我国医药产业的影响——基于SCP范式的综述研究[J].中国卫生政策研究,2023,16(12):40-48.
[14] 国家医疗保障局.医保基金与集采药品耗材、国谈药企业直接结算加速落地企业回款周期从6个月减为30天[EB/OL].(2025-02-10)[2026-06-24].https://www.nhsa.gov.cn/art/2025/2/10/art_14_15653.html.
[15] 伍琳,李梦颖.医保支付激励与医生多任务执行偏差——新的解释框架和政策启示[J].中国卫生政策研究,2022,15(1):37-42.
[16] 王红波,元瑾,孙向谦.我国医保监管的历史进路、演变逻辑和未来展望—基于历史制度主义的分析[J].中国卫生政策研究,2022,15(6):1-8.
[17] 马亮. 数字政府建设:文献述评与研究展望[J].党政研究,2021(3):99-111.
[18] 曾望峰.大数据助推实现医保治理现代化:价值、现状与路径[J].卫生经济研究,2023,40(9):33-35+39.
[19] Agbo C C, Mahmoud Q H, Eklund J M.Blockchain technology in healthcare:a systematic review[J]. Healthcare, 2019, 7(2):56.
