中国医疗保障发展报告(2024)
中文摘要
《中国医疗保障发展报告(2024)》以“数字化促医疗保障治理现代化”为主题,全面且系统地探讨了医保治理数字化转型的重要性、发展脉络与进展、实践成果,以及未来的发展策略。报告不仅对数字化在医疗保障治理现代化中的作用进行了总体评价,还深入分析和评估了医疗保障的标准化建设、公共服务平台建设、信息共享、数据安全、基金监管数字化,以及医保大数据的开发利用。此外,报告还客观地反映了江苏省和河北正定县在医保数字化方面的进展,展示了中南大学湘雅三医院、老百姓大药房、国新健康等机构在医保数字化建设方面的典型案例。
报告强调,我们已置身于一个不可逆转的数字化时代。医疗保障作为涉及人民群众切身利益且唯一覆盖全民的社会保障制度,迫切需要通过数字化转型来实现治理的现代化。数字化转型能够显著提高医保管理的效率,降低运行风险,并通过数据分析来优化政策和资源的配置。这一转型对于应对时代发展、提升治理效率、确保基金安全,以及促进医疗、医保、医药“三医”协同具有重要意义。
报告指出,经过前期探索和2018年国家医保局成立以来的有效行动,我国医保治理数字化转型取得了显著进展,开始全方位服务于医保事业的健康发展。全国统一的医保标准体系和信息平台的建立,为医保治理现代化打下了坚实的基础,实现了从国家到省、市、县四级医保信息的互联互通,覆盖了超过90万家定点医药机构,为全国13.4亿参保人提供服务。大数据的应用为医保基金监管提供了强有力的技术支撑,使得监管工作更加精准和高效。同时,地方医保治理数字化转型的创新实践,如广东、浙江、山东等地的探索,已成为趋势,推动了医保服务向便捷化和智能化发展。这些进展不仅实质性提升了医保治理水平,也形成了广泛共识,即以医保标准化、信息化建设为抓手,将数字化转型融入医保改革及提升经办服务能力中。
报告指出,虽然医保治理数字化转型的任务尚未完全实现,医保治理现代化的进程还须更全面地推进,但目前所取得的重大进展已经彰显了以往工作的实质性成效,并凸显了医保治理数字化转型不可替代的优势。在此过程中积累的以下基本经验值得高度重视,并应在未来的发展规划中继续得到巩固和应用。在思想认识层面,强化国家意识和全局观念,确保了医保制度在国家层面的重要性和标准的统一性;在组织措施方面,国家层级的直接领导和自上而下的纵向推进策略,保障了相关制度建设沿着公平正义的轨道稳健运行;在行动方式上,科学的顶层设计和统一标准的实施,确保了医保标准化和信息化建设的顺利进行;在技术层面,充分利用第三方力量,不仅弥补了医保部门的能力不足,还显著提升了医保管理的效率和精准度。这些经验为未来医保治理数字化转型的深入发展提供了重要的参考,预示着以数字化为显著特征的医保治理现代化进程将显著加快。
报告建议,面对中国式现代化进程的全面加速以及医保制度理性建制和定型发展的客观需求,应当进一步提升对数字化转型以及利用数字智能技术为医保治理现代化赋能的重要性的认识,加快健全完善医保标准化、信息化体系,切实维护医保数据安全,进一步增进部门之间的协同,继续发挥第三方力量助力医保治理现代化的作用,有序开发利用医保数据。通过这些措施,可以更好地赋能医保政策决策、提升治理效率、优化服务体验,并持续推动“三医”高效协同发展,带给全体人民更加公平普惠、更加有力有效的医疗与健康保障。
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总报告
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