“基本医疗保险付费总额控制”的行政法省思

基本医疗保险实施过程中必然存在政府职能外包的现象。人社部、财政部、原卫生部联合下发的《关于开展基本医疗保险付费总额控制的意见》以行政规划的形式把基本医疗保险付费总额控制纳入定点医疗服务协议,是对基本医保过程中政府职能外包的行政法规制。该规制以绩效为导向,导致政府职能外包过程中出现了公私绩效诉求的叠加效应,矮化了权利保障之初始目标。

Reflection on the Maximum Payment for the Basic Medical Insurance

Outsourcing of government functions exists in the process of implementing the basic medical insurance. In the form of administrative planning, Opinions on the Maximum Payment for the Basic Medical Insurance subsumes the measure into the designated medical service agreement, which are essentially the administrative regulations to the outsourcing of government functions in the basic medical insurance. The performance-oriented regulation leads to the emergence of superimposed effect of public and private performance demands in the process of outsourcin~ of ~overnment functions, which dwarfs the initial target to guarantee rights.