[1]谭华伟,黄二丹,陈迎春,等.紧密型县域医共体医保总额付费： 理论阐释、关键议题和治理之道[J].卫生经济研究,2025,42(11):49-53.
　TAN Huawei,HUANG Erdan,CHEN Yingchun,et al.Global Budget Payment for County-Level Compact Medical Communities: Theoretical Framework, Essential Dimensions, and Governance Strategies[J].Journal Press of Health Economics Research,2025,42(11):49-53.
点击复制

紧密型县域医共体医保总额付费： 理论阐释、关键议题和治理之道

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
42
期数:
2025年11期
页码:
49-53
栏目:
医疗保障
出版日期:
2025-11-04

文章信息/Info

Title:
Global Budget Payment for County-Level Compact Medical Communities: Theoretical Framework, Essential Dimensions, and Governance Strategies
作者:
谭华伟1; 黄二丹2; 陈迎春1; 郭丹丹3; 毕圣贤1; 张雪雨1; 姚 辉4
1.华中科技大学同济医学院医药卫生管理学院，湖北 武汉 430030
2.国家卫生健康委卫生发展研究中心，北京 100044
3.湖北医药学院，湖北 十堰 442000
4.霍邱县第一人民医院，安徽 六安 237400
Author(s):
TAN Huawei;  HUANG Erdan;  CHEN Yingchun;  GUO Dandan;  BI Shengxian;  ZHANG Xueyu;  YAO Hui
School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan Hubei 430030, China
关键词:
县域医共体; 总额付费; 预算管理; 分级分类
Keywords:
county-level medical communities;  global budget payment;  budget management;  tiered and categorized
分类号:
R19
文献标志码:
A
摘要:
紧密型县域医共体建设是连接健康优先发展战略、健康中国战略与乡村振兴战略的关键场域。医保总额付费是医共体内部构建激励相容机制的核心工具，目标是激励医共体为区域人群健康和卫生费用负责。当前，医共体总额付费改革在预算管理、财务基准、结算管理、清算管理等关键议题上存在争议。对此，文章进行了阐释与梳理，并提出治理路径：实施分级分类预算和双预算管理，推动县域财务基准向市域财务基准过渡，夯实结算、监管、赋能一体化，促进利益外部化转向利益内部化。
Abstract:
The construction of county-level compact medical communities is a key field connecting the health priority development strategy, the Healthy China strategy, and the rural revitalization strategy. Global budget payment represents a core policy tool for fostering incentive-compatible mechanisms within county-level compact medical communities, aiming to motivate them to be accountable for regional population health and healthcare expenditures. At present, there are controversies over key issues such as budget management, financial benchmarks, settlement management, and cleaning management in the reform of Global budget payment system for medical communities. In this regard, the article clarifies and systematizes these issues, proposing governance pathways. It is necessary to implement tiered and categorized budgeting and dual-budget management, transition county-level financial benchmarks toward municipal-level benchmarks, strengthen the integration of settlement, supervision, and empowerment, and promote the shift from externalisation to internalisation of interests.

参考文献/References:

[1] 李力，郑英.总额预付制下县域医共体激励约束机制分析：个人利益与集体利益的冲突[J].公共管理与政策评论，2023，12（01）：140-155.
[2] 邢怡青，贺睿博，李浩淼，等.县域医保支付与医疗服务结构适配关系与机理——基于云县典型案例的分析[J].中国卫生政策研究，2023，16（05）：1-7.
[3] 龚光雯，唐昌敏，郭丹丹，等.县域医共体总额预付激励效应的影响因素研究——基于24个案例的清晰集定性比较分析[J].中国卫生政策研究，2023，16（07）：10-15.
[4] 王红波，张开然，龚曦.县域医共体与医保的协同发展：理论缘由、实践困境与优化策略[J].中国卫生政策研究，2023，16（09）：1-7.
[5] McWilliams J M,Hatfield L A, Landon B E,et al.Savings or selection?Initial spending reductions in the Medicare Shared Savings Program and considerations for reform[J].Milbank Q,2020,98(03):847-907.
[6] Douven R,McGuire T G,McWilliams J M.Avoiding unintended incentives in ACO payment models[J].Health Aff (Millwood),2015,34(01):143-149.
[7] Lyu P F,Chernew M E,McWilliams J M.Benchmarking changes and selective participation in the Medicare Shared Savings Program[J].Health Aff (Millwood),2023,42(05):622-631.
[8] Mühlbacher A C,AmelungV E,Juhnke C.Contract design: financial options and risk[J].Int J Integr Care,2018,18(01):2.
[9] 郁建兴，涂怡欣，吴超.探索整合型医疗卫生服务体系的中国方案——基于安徽、山西与浙江县域医共体的调查[J].治理研究，2020，36（01）：5-15，2.
[10] 谭华伟，彭馨怡，姚辉，等.中国紧密型城市医疗集团建设：典型模式、关键问题与路径优化[J].中国卫生政策研究，2024，17（01）：9-16.
[11] Cattel D,Eijkenaar F.Value-Based provider payment initiatives combining global payments with explicit quality incentives: a systematic review[J].Med Care Res Rev,2020,77(06):511-537.[12] Rose S,Zaslavsky A M,McWilliams J M.Variation in Accountable Care Organization spending and sensitivity to risk adjustment: implications for Benchmarking[J].Health Aff (Millwood),2016,35(03):440-448.
[13] 顾雪非，刘小青.从数量到价值：医保支付如何驱动医疗卫生体系整合[J].卫生经济研究，2020，37（01）：7-10.
[14] Or Z.Implementation of DRG payment in France: issues and recent developments[J].Health Policy,2014,117(02):146-150.

相似文献/References:

[1]陶生生,梅光亮,白忠良,等.基于社会网络理论的县域医共体建设思考[J].卫生经济研究,2018,(09):21.
　TAO Sheng-sheng,MEI Guang-liang,BAI Zhong-liang,et al.houghts on the Construction of County Medical Community Based on Social Network Theory[J].Journal Press of Health Economics Research,2018,(11):21.
[2]张 平.县域医共体建设的浙江承载[J].卫生经济研究,2018,(12):3.
　ZHANG Ping.Zhejiang Bearing of County Medical Community Construction[J].Journal Press of Health Economics Research,2018,(11):3.
[3]申丽君,黄成凤,李乐乐,等.县域医共体模式的探索与实践——以安徽省天长市为例[J].卫生经济研究,2018,(12):7.
　SHEN Li-jun,HUANG Cheng-feng,LI Le-le,et al.Exploration and Practice of County Medical Community Model——Taking Tianchang City，Anhui Province as An Example[J].Journal Press of Health Economics Research,2018,(11):7.
[4]江蒙喜.县域医共体改革发展效果的评价指标体系构建——基于浙江省德清县的案例研究[J].卫生经济研究,2018,(12):11.
　JIANG Meng-xi.Construction of Evaluation Index System for the Effect of County Medical Community Reform and Development——Based on the Case Study of Deqing ProvinceCounty，Zhejiang[J].Journal Press of Health Economics Research,2018,(11):11.
[5]杨金仙,刘春平,蔡克伟,等.县域医共体背景下基层护理学科与人才队伍建设的思考[J].卫生经济研究,2019,(06):61.
　YANG Jin-xian,LIU Chun-ping,CAI Ke-wei,et al.Thoughts on the Construction of Basic Nursing Discipline and Talent Team under the Background of County Medical Community[J].Journal Press of Health Economics Research,2019,(11):61.
[6]樊丹燕,戎珊珊,刘建武.县域医共体背景下基层医疗机构检验服务能力研究[J].卫生经济研究,2020,(05):31.
　FAN Dan-yan,RONG Shan-shan,LIU Jian-wu.Research on Inspection Service Ability of Primary Medical Institutions under the Background of County-level Medical Alliance[J].Journal Press of Health Economics Research,2020,(11):31.
[7]江蒙喜.县域医共体建设中促进“共”的实践路径探讨[J].卫生经济研究,2020,(06):3.
　JIANG Meng-xi.Discussion on the Practical Path of Promoting “Community” in the Construction of County Medical Community[J].Journal Press of Health Economics Research,2020,(11):3.
[8]孙弋涵,沈 晓,徐一明.基于整体性治理理论的县域医共体建设研究——以湖北省为例[J].卫生经济研究,2020,(10):24.
　SUN Yi-han,SHEN Xiao,XU Yi-ming.Study on the County-level Medical Alliance Construction Based on Integration Governance Theory——Take Hubei Province as an example[J].Journal Press of Health Economics Research,2020,(11):24.
[9]吴金华.县域医共体如何开展公共卫生工作——以慈溪市为例[J].卫生经济研究,2020,(10):27.
　WU Jin-hua.How to Carry out Public Health Work in the County-Level Medical Alliance —— Taking Cixi City as an Example[J].Journal Press of Health Economics Research,2020,(11):27.
[10]王 婷,黄家昌.政府会计制度下县域医共体会计核算体系构建研究[J].卫生经济研究,2020,(10):30.
　WANG Ting,HUANG Jia-chang.Study on the Construction of Accounting system in County-Level Medical Alliance Under the Government Accounting System[J].Journal Press of Health Economics Research,2020,(11):30.
[11]樊 淼,李之淳,杜金芮,等.县域医共体医保总额付费效果研究[J].卫生经济研究,2025,42(01):48.
　FAN Miao,LI Zhichun,DU Jinrui,et al.Study on the Effect of Global Budget of Medical Insurance in County-level Medical Community[J].Journal Press of Health Economics Research,2025,42(11):48.

更新日期/Last Update: 2025-11-04