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基本医疗保险与商业健康保险数据协同的推进策略OA

Strategies for advancing data collaboration between basic medical insurance and commercial health insurance

中文摘要英文摘要

"数据协同"是促进基本医疗保险与商业健康保险深度协同的重要突破口,但多元价值目标协调难、多主体职责交叠、磋商平台和激励契约缺失等深层次问题急需理论支撑.本文在系统探讨基本医疗保险与商业健康保险数据协同的"需求端弥合力+产品端转型增效力+政策端韧性监管力"动力机理的基础上,提出以价值目标动态平衡为中心,以协同结构激励相容为切入点,以可信数据安全高效流通为基准的政策构想.建议补充完善"公共价值指引+价值审查"规则,健全"线下组织协同+线上多维多层次数据协同平台"架构,推进"绩效挂钩+疗效数据共享",加强数据协同风险综合监控能力,畅通可信数据高效流通通道.

Data collaboration provides a key entry point for deepening the integration between basic medical insurance and commercial health insurance.However,addressing structural issues such as conflicting value objectives,overlapping responsibilities,and the absence of consultation and incentive mechanisms requires robust theoretical guidance.By analyzing driving mechanisms targeting demand gaps,product innovation,and regulatory resilience,this article proposes a policy framework focused on the dynamic balance of value objectives.This framework adopts incentive compatibility within collaborative structures as a starting point and establishes secure and efficient data circulation as a benchmark.Policy recommendations include refining rules for public value guidance and auditing,and integrating offline coordination with online data platforms.Furthermore,the article advocates for performance-linked mechanisms,clinical outcome data sharing,and comprehensive risk monitoring to facilitate the secure circulation of trusted data.

高红;赵宏禹;管仲军

黑龙江大学政府管理学院,黑龙江 哈尔滨 150080黑龙江大学政府管理学院,黑龙江 哈尔滨 150080首都医科大学宣武医院,北京 100053

医药卫生

基本医疗保险商业健康保险数据协同

basic medical insurancecommercial health insurancedata collaboration

《健康发展与政策研究》 2026 (1)

18-23,6

国家社会科学基金一般项目(19BZZ093)2024年度首都卫生发展科研专项项目(首发2024-1G-2013)2023年度黑龙江省哲学社会科学研究规划项目(23JLB091)

10.12458/HDPR.202510023

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