[1]易孝婷,吴钜凌,李乐乐,等.紧密型县域医共体健康导向型医保支付方式改革研究 ——基于整体性治理理论[J].卫生经济研究,2026,43(07):42-45,51.
　YI Xiaoting,WU Juling,LI Lele,et al.Research on Health-Oriented Medical Insurance Payment Reform in Compact County-Level Medical Communities——Based on Holistic Governance Theory[J].Journal Press of Health Economics Research,2026,43(07):42-45,51.
点击复制

紧密型县域医共体健康导向型医保支付方式改革研究
——基于整体性治理理论

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
43
期数:
2026年07期
页码:
42-45,51
栏目:
医疗保障
出版日期:
2026-07-03

文章信息/Info

Title:
Research on Health-Oriented Medical Insurance Payment Reform in Compact County-Level Medical Communities
——Based on Holistic Governance Theory
作者:
易孝婷1; 吴钜凌1; 李乐乐2; 顾亚明3; 郝 倩3
1.湖州市南浔区菱湖人民医院，浙江 湖州 313000
2.中国人民大学劳动人事学院，北京 100872
3.杭州医学院卫生健康政策研究院，浙江 杭州 310013
Author(s):
YI Xiaoting;  WU Juling;  LI Lele;  GU Yaming;  HAO Qian
Linghu People's Hospital, Nanxun District Huzhou, Huzhou Zhejiang 313000, China
关键词:
紧密型县域医共体; 健康导向型医保支付; 整体性治理
Keywords:
compact county-level medical communities;  health-oriented medical insurance payment;  holistic governance
分类号:
R19
文献标志码:
A
摘要:
整体性治理理论强调以公众需求为治理导向，以协调、整合、责任为治理机制，为紧密型县域医共体的医保支付方式改革提供了新思路。本研究中的案例医共体聚焦医保支付工具系统融合，形成“DRG点数法+按人头预付+健康绩效奖励”的多元复合支付体系；构建分级预算体系，实现医保基金在“治疗—预防—康复”环节的合理分配；通过数智化监管与绩效评价，将慢病控制率、人均期望寿命等健康结果与医保支付直接挂钩，形成“支付—服务—健康”闭环激励机制，在提升医疗服务能力、优化医院收入结构、引导医疗行为等方面初见成效。紧密型县域医共体的健康导向型医保支付方式改革，须强化政策目标协同，建立医保基金分级预算机制，构建整合型健康管理服务体系，应用数字技术工具实现医保智慧监管，从而推动医共体向健共体转型发展。
Abstract:
Holistic governance theory, which emphasizes public demand as the governance orientation and coordination, integration, and accountability as governance mechanisms, offers new insights for medical insurance payment reform in compact county-level medical communities. The case medical community in this study focused on the systematic integration of payment tools, forming a diversified composite payment system of "DRG point method + per capita prepayment + health performance rewards". A tiered budget system was established to achieve rational allocation of medical insurance funds across "treatment-prevention-rehabilitation" stages. Through digital supervision and performance evaluation, health outcomes such as chronic disease control rates and life expectancy were directly linked to medical insurance payments, creating a closed-loop incentive mechanism of "payment-service-health." Preliminary results were observed in improving medical service capacity, optimizing hospital revenue structure, and guiding medical behaviors. To advance health-oriented payment reform in compact county-level medical communities, it is necessary to strengthen policy goal coordination, establish a tiered budget mechanism for medical insurance funds, build an integrated health management service system, and apply digital technologies to achieve smart medical insurance supervision, thereby promoting the transformation of medical communities into health communities.

参考文献/References:

[1] 刘亚孔，李晓燕.某市紧密型县域医共体医保支付模式优化研究[J].中国医院，2023，27（06）：15-17.
[2] 宫芳芳，孙喜琢，王承馨.以居民健康管理为核心实现医保支付方式突破性改革[J].中国医院，2016，20（11）：59-61.
[3] Patrick Dunleavy, Helen Margetts, Simon Bastow, et al. New public management is dead-long live digital-era governance[J]. Journal of Public Administration Research and Theory, 2006, 16(03): 467-494.
[4] 刘庆，施文凯.基于整体性治理理论的基层政府治理创新研究[J].东岳论丛，2024，45（02）：160-166.
[5] 张梓洵，尹刚，边颖，等.紧密型县域医共体下人头总额预付与DRG付费协同机制研究：基于整体性治理视角[J].中国全科医学，2025，28（19）：2441-2448.
[6] 赵春琰，郭维淋，黄泽成，等.公共卫生、医疗服务、医疗保障多体系协同机制研究——基于整体性治理理论视角[J].中国卫生事业管理，2021，38（03）：171-174.
[7] 沈晓，毛宗福，肖红军，等.整体性治理：医保支付方式改革下的“三医”协同发展和治理[J].中国医疗保险，2025（05）：13-19.
[8] 韩瑞波.整体性治理在国家治理中的适用性分析：一个文献综述[J].吉首大学学报（社会科学版），2016，37（06）：67-73.
[9] 姚轶凡，林坤河，钟正东，等.医保按人头付费对医共体慢病管理的治理机制研究——基于整体性治理视角[J].中国卫生政策研究，2023，16（03）：30-36.
[10] 邓晓欣，姚中进.三明医改经验推广的阻滞因素与整体性治理路径研究[J].中国医院管理，2022，42（04）：1-4.
[11] 王淑敏，徐赞，崔文虎，等.整体性治理视域下完善医保基金管理的思考[J].卫生经济研究，2022，39（11）：16-18，22.
[12] 李甜，张筱荣.长三角地区人口老龄化程度演变及对策探究[J].福建医科大学学报（社会科学版），2024，25（02）：7-14，72

相似文献/References:

[1]谭华伟,陈迎春.紧密型县域医共体对医保患者住院成本分担的效应研究 ——基于双重差分法的实证经验[J].卫生经济研究,2023,40(8):45.
　TAN Huawei,CHEN Yingchun.Study on the Effects of Compact County-level Medical Community Reform on Hospitalization Cost-sharing for Medical Insurance Patients ——Empirical Experience based on Double Difference Method[J].Journal Press of Health Economics Research,2023,40(07):45.
[2]王书平,孙 雯,吴 迪,等.紧密型县域医共体药物协同政策研究[J].卫生经济研究,2024,41(03):15.
　WANG Shuping,SUN Wen,WU Di,et al.Study on Drug Collaboration Policy of Compact County-level Medical Community[J].Journal Press of Health Economics Research,2024,41(07):15.
[3]邓 蒙,冯启明,彭 蓉.广西紧密型县域医共体试点地区乡镇卫生院运行效率研究 ——基于Bootstrap-DEA和Tobit模型[J].卫生经济研究,2024,41(04):14.
　DENG Meng,FENG Qiming,PENG Rong.Study on the Operational Efficiency of Township Health Centers in the Pilot Areas of Compact County-level Medical Community in Guangxi ——Based on Bootstrap-DEA and Tobit Model[J].Journal Press of Health Economics Research,2024,41(07):14.
[4]周春泥,谢瑞瑾,马玉龙,等.安徽省紧密型县域医共体经济运行效率及其影响因素研究 ——基于三阶段DEA和Tobit回归分析[J].卫生经济研究,2024,41(07):15.
　ZHOU Chunni,XIE Ruijin,MA Yulong,et al.Study on the Economic Operation Efficiency and its Influencing Factors of Compact County-level Medical Community in Anhui Province ——Based on Three-stage DEA Model and Tobit Regression Analysis[J].Journal Press of Health Economics Research,2024,41(07):15.
[5]兰 珍,刘 婧,陈火旺,等.紧密型县域医共体医防融合促进慢病管理研究 ——以福建省三明市为例[J].卫生经济研究,2024,41(11):74.
　LAN Zhen,LIU Jing,CHEN Huowang,et al.Study on Promoting Chronic Disease Management by the Integration of Medical Care and Prevention in Compact County-level Medical Community ——Taking Sanming City of Fujian Province as an Example[J].Journal Press of Health Economics Research,2024,41(07):74.
[6]阮博宇,边云凤,马宇豪,等.紧密型县域医共体 医保总额预算典型模式及优化路径[J].卫生经济研究,2025,42(06):63.
　RUAN Boyu,BIAN Yunfeng,MA Yuhao,et al.Study on Typical Model of and Optimization Path of Total Budget in Medical Insurance in Compact County-level Medical Community[J].Journal Press of Health Economics Research,2025,42(07):63.
[7]赵婧萱,顾 梅,侯新宇,等.紧密型县域医共体医保支付方式改革现状研究[J].卫生经济研究,2025,42(09):58.
　ZHAO Jingxuan,GU Mei,HOU Xinyu,et al.Study on the Current Status of Medical Insurance Payment Method Reform in Compact County-Level Medical Communities[J].Journal Press of Health Economics Research,2025,42(07):58.
[8]张 岚,姚棵林,许才明.紧密型县域医共体建设背景下中心乡镇卫生院服务能力提升研究[J].卫生经济研究,2025,42(09):62.
　ZHANG Lan,YAO Kelin,XU Caiming.Study on Enhancing the Service Capacity of Central Township Health Centers under the Context of Compact County-Level Medical Community Construction[J].Journal Press of Health Economics Research,2025,42(07):62.
[9]方 敏,王敏娇,严运楼.县域医共体下慢性病“防—治—管” 一体化治理创新路径研究[J].卫生经济研究,2025,42(12):48.
　FANG Min,WANG Minjiao,YAN Yunlou.Study on the Innovative Path for Integrated Governance of Chronic Diseases through "Prevention, Treatment, and Management" under County-Level Medical Community[J].Journal Press of Health Economics Research,2025,42(07):48.
[10]杨 龙,张 倩,江 林,等.紧密型县域医共体医学影像资源共享中心信息化功能指标体系研究[J].卫生经济研究,2026,43(04):59.
　YANG Long,ZHANG Qian,JIANG Lin,et al.Study on the Informationization Function Indicator System for Medical Imaging Resource Sharing Centers in Compact County-level Medical Communities[J].Journal Press of Health Economics Research,2026,43(07):59.

更新日期/Last Update: 2026-07-03