Formative pathways of medical insurance fund surplus in county medical communities:A transaction cost theory perspective
10.3969/j.issn.1674-2982.2025.05.003
- VernacularTitle:基于交易成本的县域医共体医保基金结余形成路径研究
- Author:
Si-si MEI
1
;
Qian HAO
;
Jie-hong GAO
;
Zhen-guo ZHU
;
Ya-ming GU
Author Information
1. 杭州医学院公共卫生学院 浙江 杭州 311399
- Publication Type:Journal Article
- Keywords:
County medical communities;
Medical insurance payment;
Surplus;
Formative pathways;
Transaction cost
- From:
Chinese Journal of Health Policy
2025;18(5):13-19
- CountryChina
- Language:Chinese
-
Abstract:
The"capitation payment with retained surplus and shared accountability for reasonable overruns"mechanism constitutes a pivotal institutional framework for advancing the high-quality development of County Medical Communities(CMCs).This study addresses two critical operational challenges:identifying the sources of medical insurance fund surplus and optimizing the governance of fund retention processes.Grounded in transaction cost theory,we develop an analytical framework examining the formation of medical insurance fund surplus through the dual lenses of intra-organizational dynamics within CMCs and external medical insurance payment mechanism design.Utilizing Deqing County,Zhejiang Province as an empirical case,this research proposes a five-pronged strategy:Clarifying generation channels of insurance fund surplus,scientifically determining regional medical insurance budgets,implementing bundled payment mechanisms for CMCs,adopting hybrid payment models integrating unified and differentiated approaches,and establishing performance-based incentive systems.These findings elucidate the formative pathways of medical insurance fund surplus while offering theoretical and practical insights for enhancing payment system reforms to support CMC development.
