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| 文章编号：1672-3104(2023)01-0134-10 |
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契约行政化：地方医疗保险支付方式改革的混合治理机制——基于F省2017—2022年的案例追踪 |
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吴文强1，2，岳经纶2 |
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（1.福建师范大学政治发展与地方治理研究中心，福建福州，350117；
2.中山大学中国公共管理研究中心/政治与公共事务管理学院，广东广州，510275） |
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| 摘 要： 既有的医疗保险支付方式改革研究大多遵循经济学的分析逻辑，聚焦微观行动者的互动博弈以及特定医疗保险支付方式的激励效应，忽略了改革的政治属性以及中国特色情境对治理结果的影响。事实上，医疗保险支付方式改革涵盖了国家行政主体和主要利益相关者之间的治理关系和互动机制的调整。聚焦F省2017—2022年的医疗保险改革过程发现，F省医疗保险部门在利用行政机制调控医疗保险支付方式改革的基础上，采用了市场机制的契约手段来明确医疗机构的权利和义务。但囿于行政机制的主导性，F省的相关政府部门与医疗机构之间并未建立完善的利益协调机制，这可能会阻碍居民健康保障的实现。本研究在把混合治理机制的运作过程概念化为“契约行政化”的基础上，厘清了其与特定政策目标之间的因果机制，进一步探讨了提升混合治理机制有效性的变革路径。 |
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| 关键词： 契约行政化；医疗保险支付方式改革；混合治理机制；利益协调；健康保障 |
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Contract administration: A mixed governance mechanism of local MIPMR seen from a case tracking based on F province from 2017 to 2022 |
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WU Wenqiang1,2, YUE Jinglun2 |
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（1. Research Center for Political Development and Local Governance, Fujian Normal University, Fuzhou 350117, China;
2. Research Center for Chinese Public Administration/ School of Governance for Politics and Public Affairs, Sun Yat-sen University, Guangzhou 510275, China） |
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| Abstract: Existing studies about the Medical Insurance Payment Method Reform (MIPMR) mostly follow the analytical logic of economics, focusing on the interactive games among micro actors and incentive effects of specific medical insurance payment methods, while ignoring the political nature of the reform and the shaping effect of the context with Chinese characteristics on governance result. In fact, the MIPMR covers the adjustment of the governance relationship and interaction mechanisms between the national administrative body and key stakeholders. Focusing on the reform process of F province from 2017 to 2022, the study finds that local medical insurance department, on the basis of taking advantage of administration mechanism in regulating and controlling MIPMR, simultaneously employs administrative mechanisms and contractual means to specify rights and duties of medical institutions. But limited by the dominating characteristics of the administrative mechanism, there has not yet been established an efficient benefit coordination mechanism between related administrative sectors and medical institutions in F province, which may hinder the realization of securing citizen health. All in all, the study, on the basis of conceptualizing the operation process of the mixed governance mechanism as “contract administration”, clarifies its cause-effect with specific policy goals, and further explores the effective reform path to boost the mixed governance mechanism. |
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Key words: contract administration; Medical Insurance Payment Method Reform (MIPMR); mixed governance mechanism; interest coordination; health security |
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