基本医保制度塑造医疗服务体系的演进逻辑及工具路径OACHSSCD

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.