| 375 | 0 | 17 |
| 下载次数 | 被引频次 | 阅读次数 |
“三医”协同作为中国医药卫生体制改革的重要创新，通过制度重塑、利益整合和治理网络构建，形成了以协作共治为核心的医药卫生治理共同体。深入探讨中国“三医”协同治理的理论内涵、历史演进、实践路径及其面临的挑战与未来发展方向，对指导未来医药卫生体制改革意义重大。从“三医”联动到“三医”协同，体现了中国医药卫生体制改革治理思路的转型；福建省三明市和浙江省德清县的医改实践，分别强调了以行政主导、医药突破和市场调节、医保治理为核心的不同改革路径。未来“三医”协同的发展方向，包括建立多元复合的医保支付体系，增强社群机制在医药卫生治理中的作用和推进价值医疗及医保价值付费，推动从以疾病治疗为中心向以人民健康为中心的转变。
Abstract：Medical Service & Basic Insurance & Drug Management Synergy is an important innovation in the reform of China's medical and health system. Through institutional restructuring, interest integration, and the establishment of governance networks, it has formed a community of medical and health governance centered on collaborative co-governance. An in-depth exploration of the theoretical connotations, historical evolution, practical pathways, challenges, and future directions of this synergy is of great significance for guiding future reforms of the medical and health system. The shift from “tri-med linkage” to “tri-med collaboration” reflects a transformation in the governance approach of China's health system reform; the healthcare reform practices in Sanming City of Fujian Province and Deqing County of Zhejiang Province emphasize different reform pathways, including administrative leadership, breakthroughs in medicine combined with market regulation, and health insurance governance. Future directions for the development of this synergy include establishing a diversified and composite health insurance payment system, enhancing the role of community mechanisms in medical and health governance,and promoting value-based healthcare, thereby achieving a transition from a diseasetreatment-centered approach to one that is centered on people's health.
[1]MONTENEGRO H,HOLDER R,RAMAGEM C,et al.Combating Health Care Fragmentation through Integrated Health Service Delivery Networks in the Americas:Lessons Learned [J].Journal of Integrated Care,2011,19(5):5-16.
[2]MAJEED A.General Practice in the United Kingdom:Meeting the Challenges of the Early 21st Century [J].Journal of the Royal Society of Medicine,2013,106(10):384-385.
[3]ARROW K J.Uncertainty and the Welfare Economics of Medical Care [J].American Economic Review,1963,53(5) :941-973.
[4]申曙光，张勃.分级诊疗、基层首诊与基层医疗卫生机构建设[J].学海，2016(2):48-57.
[5]高和荣.健康治理与中国分级诊疗制度[J].公共管理学报，2017(2):139-144.
[6]刘晓婷，黄洪.医疗保障制度改革与老年群体的健康公平——基于浙江的研究[J].社会学研究，2015(4):94-117.
[7]王文涛，付剑峰，朱义.企业创新、价值链扩张与制造业盈利能力——以中国医药制造企业为例[J].中国工业经济，2012(4):50-62.
[8]STOKER G.Governance as Theory:Five Propositions [J].International Social Science Journal,1998,50(155):17-28.
[9]翟绍果.“三医”联动的逻辑、机制与路径[J].探索，2017(5):78-83.
[10]陈仰东.三医联动的内涵、意义与机制建设[J].中国医疗保险，2016(10):19-21.
[11]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(1):5-15.
[12]赵云，农乐根.对医疗保险付费方式改革的总认识[J].卫生经济研究，2013(10):9-12.
[13]顾昕.全民免费医疗的市场化之路：英国经验对中国医改的启示[J].东岳论丛，2011(10):25-31.
[14]胡善联.中国医改的焦点、难点和痛点[J].卫生经济研究，2015(12):3-7.
[15]仇雨临.医保与“三医”联动：纽带、杠杆和调控阀[J].探索，2017(5):65-71.
[16]杨燕绥，廖藏宜.医保助推三医联动重在建立机制——以金华医保为例[J].中国医疗保险，2017(9):11-13.
[17]郑秉文，韦玮.中国医保支付体系改革25年：成就、问题与展望[J].社会保障评论，2024(3):75-89.
[18]刘晓婷，吕豪.从被动支付到战略购买：药品集采对医药企业的影响研究[J/OL].南开管理评论，2024:1-23[2024-12-01].http://kns.cnki.net/kcms/detail/12.1288.F.20240611.1026.002.html.
[19]王震.公立医院改革与三医联动[J].中国医疗保险，2016(10):9-12.
[20]高和荣.以医疗为中心的“三医”联动改革：路径与策略[J].南京社会科学，2018(7):65-71.
[21]高和荣.医保统领“三医联动”改革的内在矛盾及消解[J].南京社会科学，2019(6):65-72.
[22]李玲，陈秋霖，江宇.中国医改：社会发展的转折[J].开放时代，2012(9):34-43.
[23]王东进.关于我国药品价格改革的几点认识与思考[J].价格理论与实践，2015(8):5-6.
[24]刘凯，和经纬.“补供方”与“补需方”对医疗费用的影响比较——基于三明市新医改的实证研究[J].北京行政学院学报，2017(6):10-17.
[25]蒋天文，樊志宏.中国医疗系统的行为扭曲机理与过程分析[J].经济研究，2002(11):71-80.
[26]顾昕.“健康中国”战略中基本卫生保健的治理创新[J].中国社会科学，2019(12):121-138.
[27]OSTROM E,PARKS R B,WHITAKER G P,et al.The Public Service Production Process:A Framework for Analyzing Police Services [J].Policy Studies Journal,1978,7(s1):381-389.
[28]岳经纶，王春晓.三明医改经验何以得到全国性推广?基于政策创新扩散的研究[J].广东社会科学，2017(5):186-197.
[29]王春晓.“三明医改”评估：卫生治理框架的分析[J].甘肃行政学院学报，2018(1):33-46.
[30]何蓓蓓，郑先平，赵锐，等.医联体内医保支付方式改革效果的系统评价[J].中国药物评价，2021(2):90-95.
[31]黄飚.试点：一种重要的中国公共政策机制[J].治理研究，2024(1):23-32.
[32]ROBYN P J,B?RNIGHAUSEN T,SOUARES A,et al.Provider Payment Methods and Health Worker Motivation in Community-Based Health Insurance:A Mixed-Methods Study [J].Social Science & Medicine,2014,108(9):223-236.
[33]ANDOH-ADJEI F X,VAN DER WAL R,NSIAH-BOATENG E,et al.Does a Provider Payment Method Affect Membership Retention in a Health Insurance Scheme?A Mixed Method Study of Ghana's Capitation Payment for Primary Care [J].BMC Health Services Research,2018,18(1):1-11.
[34]OR Z.Implementation of DRG Payment in France:Issues and Recent Developments [J].Health Policy,2014,117(2):146-150.
[35]MENG Z L,HUI W,CAI Y Y,et al.The Effects of DRGs-Based Payment Compared with Cost-Based Payment on Inpatient Healthcare Utilization:A Systematic Review and Meta-Analysis [J].Health Policy,2020,124(4):359-367.
[36]COOK A,AVERETT S.Do Hospitals Respond to Changing Incentive Structures?Evidence from Medicare's 2007 DRG Restructuring [J].Journal of Health Economics,2020,73(5):102319.
①数据来源：https://www.oecd.org/en/data/datasets/oecd-health-statistics.html。
(1)信息来源:转载新京报《国家卫生健康委在全国推广三明医改经验,个别地方不想学不想干》,参见https://www.bjnews.com.cn/detail/1716467135129762.html。
(2)数据来源:《遵义市全面推广三明市医改经验持续深化医药卫生体制改革实施意见(2025—2027年)》。
(3)信息来源:江山市人民政府官网,参见https://www.jiangshan.gov.cn/art/2023/2/3/art_1229080912_3661684.html。
基本信息:
DOI：10.14134/j.cnki.cn33-1337/c.2025.02.002
中图分类号:R197.1
引用信息:
[1]刘晓婷,吕豪.“三医”协同：中国健康治理的改革路径[J].浙江工商大学学报,2025,No.191(02):12-24.DOI:10.14134/j.cnki.cn33-1337/c.2025.02.002.
基金信息:
国家社会科学基金重大专项“促进养老事业和养老产业发展的政策和机制研究”(24ZDA092); 国家自然科学基金重点项目“提升基层医疗卫生服务能力研究”(71734005)