我国医疗保障管理问责研究.pdfVIP

12 中国医疗管理科学2014年11月第4卷第4期  Chinese Journal of Medical Management Sciences, November 2014, Vol.4 No.4 ·医疗管理科学论坛· 我国医疗保障管理问责研究 张忠朝… 【摘要】 为研究探索我国医疗保障管理的变化对问责关系的影响。研究问责的文献日益增多，其整体假 设是问责机制中参与者的数量在上升，问责关系变得更加多样化和复杂化，而且这些变化可能带来相互矛 盾的问责关系，最终导致“多重问责紊乱”。文章从“谁应负责、对谁负责、负责什么”3个维度对我国医 疗保障管理中不同参与者及其所需信息进行分析，力图探究这些假设。研究发现，制度的整合和组织管理 结构上的优化，使得问责链条趋于单一化、规范化和程序化，社会问责应得到有效的加强。 【关键词】 医疗保障管理；问责；研究 Study on Chinas Health Security Management Accountability ZHANG Zhongchao. School of Labor and Human Resources, Renmin University of China, Beijing 310090, China. 【 】 Abstract This paper is to study the influence of medical security management on accountability relationship in China. There are more and more literatures about the accountability. The overall assumption is the increase of the number of participants in the accountability mechanism. The accountability relationship also becomes more diversified and complicated, and these changes may lead to conflicting accountability relationship, and eventually lead to multiple accountability disorder. From the perspective of who should be responsible, to whom it is in charge of and responsible for what, this paper analyzes different participants and the required information in Chinas medical security management, and tries to explore these assumptions. The study finds that the system integration and optimization in the organizational management structure makes the accountability chain simplified, standardized and programmed. The social accountability should be effectively enhanced. 【 】 Key Words Medical security management; Accountability; Study 1 引言 现，治理中参与者的多元化会使得问责机制出现许多 医疗保障管理过程中需要建立新的机构和问责形 问题，从而削弱了参与者的责任，且无法对参与者进 式，以加强中央政府和地方政府之间的责任关系。在 行制裁。Flinders…[2]…对日益发展的问责体系提出了批评 这一过程中需要创造新的治理体系，使之通过网络体 和质疑，指出“从统治到治理转变的这一‘公理’具 系来制定和实施医疗保障政策，这些网络体系包括不