中共天津市委党校学报2026，Vol.28Issue(3)：50-62,13.DOI:10.16029/j.cnki.1008-410X.2026.03.005
基本医保制度塑造医疗服务体系的演进逻辑及工具路径
The Evolutionary Logic and Policy Instrument Pathways Through Which Basic Medical Insurance System Shapes the Medical Service System
摘要
Abstract
Driven by the deepening reform of the medical security system and the Healthy China ini-tiative,China's basic medical insurance system is gradually evolving beyond a mere reimbursement mechanism into a key institutional force restructuring the medical service system.By embedding designated medical insurance management into the medical service system,the state regulates medi-cal and pharmaceutical resource allocation through access control,exit adjustment,and layout guid-ance,thereby promoting structural optimization of medical services.The evolution of designated medical and pharmaceutical resource allocation has followed a trajectory from administrative access and contractual governance to rule-based reconstruction and planning-oriented governance.This ev-olutionary process reflects an integrated logic in which demand responsiveness drives institutional formation,payment embedding promotes functional transformation,and planning-based governance enables institutional expansion.Accordingly,medical resource allocation is shifting from quantita-tive expansion toward structural optimization,allowing the basic medical insurance system to grad-ually form a governance path that reshapes the medical service system through structural guidance.At the policy instrument level,basic medical insurance is embedded in the process of healthcare re-source allocation through a combination of regulatory constraints,targeted guidance,payment guidance,and risk control,promoting a shift in healthcare resource allocation from passive adminis-tration to proactive governance.关键词
基本医保制度/医疗服务体系/医保定点管理/定点医药服务资源配置Key words
basic medical insurance system/medical service system/designated medical insurance management/allocation of designated medical and pharmaceutical service resources分类
社会科学引用本文复制引用
胡国恒,王增文,喻姿..基本医保制度塑造医疗服务体系的演进逻辑及工具路径[J].中共天津市委党校学报,2026,28(3):50-62,13.基金项目
本文为河北省哲学社会科学规划课题"医联体建设对优质医疗资源配置的均衡效应及优化路径研究"(批准号HB23GL027)的阶段性研究成果. （批准号HB23GL027）
