[1]钱嘉琳,覃玉如,李 欣,等.医保打包支付下紧密型县域医共体监管机制研究[J].卫生经济研究,2026,43(09):11-15,20.
　QIAN Jialin,QIN Yuru,LI Xin,et al.Research on the Supervision Mechanism of Compact County-Level Medical Communities under Medical Insurance Global Payment[J].Journal Press of Health Economics Research,2026,43(09):11-15,20.
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医保打包支付下紧密型县域医共体监管机制研究

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
43
期数:
2026年09期
页码:
11-15,20
栏目:
专题研究：县域医共体
出版日期:
2026-09-02

文章信息/Info

Title:
Research on the Supervision Mechanism of Compact County-Level Medical Communities under Medical Insurance Global Payment
作者:
钱嘉琳1; 覃玉如2; 李 欣1; 农 圣1; 黄二丹3
1.右江民族医学院，广西 百色 533000
2.右江民族医学院附属医院，广西 百色 533000
3.国家卫生健康委卫生发展研究中心，北京 100032
Author(s):
QIAN Jialin;  QIN Yuru;  LI Xin;  NONG Sheng;  HUANG Erdan
Youjiang Medical University for Nationalities, Baise Guangxi 533000, China
关键词:
数量—质量—效果; 紧密型县域医共体; 监管机制; 医保打包支付
Keywords:
quantity-quality-outcome;  compact county-level medical communities;  supervision mechanism;  medical insurance global payment
分类号:
R197.32
文献标志码:
A
摘要:
医保打包支付下，紧密型县域医共体监管面临新的挑战，亟须构建精细化穿透式监管机制，切实保障医保基金安全使用。对此，采用德尔菲法筛选出26个指标，从“数量—质量—效果”三个维度构建监管体系，通过设定关键指标的监测阈值与预警功能，实现对医共体运行情况的动态捕捉与反馈，将医共体工作量、服务质量、健康结果与医保打包资金分配挂钩，配套差异化激励约束策略，促使医共体提升医疗服务效率与质量，推动优质医疗资源下沉，切实增强参保群众的获得感。
Abstract:
Under medical insurance global payment, the supervision of compact county-level medical communities faces new challenges, necessitating the establishment of a refined and penetrating supervision mechanism to ensure the safe use of medical insurance funds. In response, the Delphi method was used to select 26 indicators, constructing a supervision system from three dimensions: "quantity-quality-outcome". By setting monitoring thresholds and early warning functions for key indicators, dynamic capture and feedback on the operation of medical communities were achieved. The workload, service quality, and health outcomes of medical communities were linked to the allocation of global payment funds, accompanied by differentiated incentive and constraint strategies, thereby promoting the improvement of medical service efficiency and quality, facilitating the downward allocation of high-quality medical resources, and enhancing the sense of gain among insured populations.

参考文献/References:

[1] 中国卫生和计划生育统计年鉴委员会.中国卫生健康统计年鉴[M].国家卫生健康委员会.第1版.北京：中国协和医科大学出版社,2018.
[2] 我国紧密型县域医共体已在全国2188个县推进[EB/OL].（2025-02-15）[2025-05-16].https://www.gov.cn/yaowen/shipin/202502/content_7003906.htm.
[3] 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.
[4] 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.
[5] 张晓蕾，王军.神经外科护士专科理论培训模式的构建与效果评价[J].卫生职业教育，2018，36（15）：135-137.
[6] 高娉，赵淑芳，薛鹏，等.城市医院支援乡镇卫生院形式评价指标体系构建——基于河北省实践[J].中国卫生政策研究，2012，5（11）：65-70.
[7] 廖冬平.医共体下医保打包支付与C-DRG的实践探索[J].中国卫生经济，2022，41（01）：49-52.
[8] 李鹏，郭清.县级中医院中医药服务能力评价体系的构建[J].浙江医学，2023，45（23）：2572-2576.
[9] 耿文垚，孙晓方，李丽，等.健康行为过程取向理论及助推策略相结合的妊娠糖尿病患者饮食管理方案的构建[J].中国护理管理，2022，22（08）：1199-1204.
[10] 张琼，唐洛秋.基于DRG的公立医院综合绩效管理体系构建[J].卫生经济研究，2024，41（04）：72-75，80.
[11] 王志刚.将DRG付费改革作为建设高质量医保的关键机制[J].中国医疗保险，2021（01）：18-20.
[12] 胡婷婷，张雨桐，吕松青，等.公立医院绩效考核研究进展与趋势分析[J].中国医院，2026，30（02）：31-35.
[13] 朱敏，陈莼，冯辉，等.以高质量发展评价为导向的公立医院手术工作量绩效考核探讨[J].中国医院，2023，27（06）：35-37.
[14] 李欣欣.J省政府推动紧密型县域医共体建设存在的问题及对策研究[D].长春：吉林大学，2022.

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[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.
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更新日期/Last Update: 2026-09-02