“三医”联动走向健康治理的实现机制——基于三明医改的纵向案例研究

庄琦¹　翟绍果²　黄春柳¹　徐天舒²

（1. 中国社会科学院大学政府管理学院；2. 西北大学公共管理学院）

内容提要：回顾中国新医改历程，以福建省三明市“三医”联动改革最为典型。基于“要素-结构-功能”系统理论分析框架，本文分析三明医改的行动策略与治理过程，进而揭示“三医”联动走向健康治理的实现机制。研究结果表明，医疗卫生体制改革需要以人民健康为中心的价值导向树立政府元治理主体权威，通过健康治理引导下的目标转型推动三医统合型联动，以“法治-数治-群治”协同的行动策略促进健康事业高质量发展。在此基础上，政府要切实承担并履行保护人民健康的责任，处理好“三医”联动的动态演进性和次序性，促成健康治理社会动员，构建健康治理合作网络。　　

关键词：医疗卫生体制；新医改；三明医改；“三医”联动；健康治理；以人民健康为中心

作者简介：庄琦，中国社会科学院大学政府管理学院副教授，北京，100102；翟绍果，西北大学公共管理学院教授、博士生导师，通信作者，西安，710060；黄春柳，中国社会科学院大学政府管理学院硕士研究生；徐天舒，西北大学公共管理学院博士研究生。

基金项目：中国社会科学院大学阐释党的二十大一般专项“三医联动视角下深化医药卫生体制改革研究”（X20230020）；国家社会科学基金一般项目“全生命周期视域下健康老龄化体系路径研究”（21BSH021）；中国社会科学院大学研究生科研项目支持计划“促进医保、医疗、医药协同发展和治理——福建三明市的做法、经验及启示”（2023-KY-90）

引用格式：庄琦,翟绍果,黄春柳,等.“三医”联动走向健康治理的实现机制——基于三明医改的纵向案例研究[J].经济与管理研究,2024,45(3):94-108.DOI:10.13502/j.cnki.issn1000-7636.2024.03.006.

　　

　　

Role of the Joint Reform of Medical Insurance, Medical Services and Pharmaceuticals in Facilitating Health Governance

—A Case Study of Sanming City

ZHUANG Qi¹, ZHAI Shaoguo², HUANG Chunliu¹, XU Tianshu²

(1. University of Chinese Academy of Social Sciences, Beijing 100102;

2. Northwest University, Xi'an 710060)

　　

　　Abstract: Reviewing the history of China's new healthcare reform, Sanming City in Fujian Province is the most typical example of the joint reform of medical insurance, medical services and pharmaceuticals (the joint reform for short). Based on the theoretical framework of element-structure-function, this paper analyzes the action strategy and governance process of the joint reform in Sanming City, revealing the mechanism through which the joint reform facilitates health governance. First, the integration and linkage of health governance elements foster mutual regulation within the systems of medical insurance, medical services and pharmaceuticals by taking the pharmaceutical reform as an opportunity. Second, optimizing and enhancing the efficiency of the health governance structure serves as a control valve for the medical insurance reform to promote mutual integration of medical insurance, medical services and pharmaceuticals. Third, fostering synergy and co-creation in the health governance functions focuses on medical service reform to promote internal and external integration of medical insurance, medical services and pharmaceuticals.

　　The findings are as follows. First, the reform of medical and healthcare systems needs to establish the authority of the government as the main body of governance with the value orientation of centering on people's health, uphold the direction of public welfare in the reform, and place utmost importance on safeguarding people's health. In addition, by strengthening cross-sectoral cooperation in governance, it is necessary to clarify and refine the boundaries of the powers and responsibilities of the health commission, the healthcare security administration, the medical products administration, the development and reform commission and other departments, to ensure policy linkage, sectoral collaboration, and joint action. Second, the goal transformation, guided by health governance, facilitates the joint action of medical insurance, medical services, and pharmaceuticals. Moreover, achieving the goals of health governance necessitates the mutual regulation and integration of the elements and structures of medical insurance, medical services, and pharmaceuticals. Thus, the efficiency of health services should be improved. Third, it is essential to promote the high-quality development of public health through a coordinated strategy encompassing the rule of law, digital governance, and public participation. On this basis, the government should effectively assume and fulfill its responsibility for protecting public health, handle the dynamic evolution and sequencing of the joint reform, promote social mobilization for health governance, and build a cooperative network for health governance.

　　Keywords: medical and healthcare system; new healthcare reform; Sanming medical reform; joint reform of medical insurance, medical services and pharmaceuticals; health governance; centering on people's health

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