杭州市智慧医保实施现状及优化路径——基于史密斯政策执行过程模型视角
Current Status and Optimisation Path of Intelligent Medical Insurance Implementation in Hangzhou City—Based on Smith’s Policy Implementation Process Modelling Perspective

在全国发展战略的促成下，浙江省积极响应智慧医保发展目标，将全省统一接入全国医保信息平台并迭代优化升级命名为“智慧医保”工程，其中杭州市成为全省医疗参保人员和“两定”机构最多、日结算量最大、信息化管理措施最细致的地市。本文从群众使用最广泛的功能——医保电子凭证角度出发，采用问卷调查的方式对杭州市智慧医保发展现状及居民使用情况进行调查，反映智慧医保政策实施现状及居民满意度。运用列联分析、随机森林等多种统计方法对智慧医保实施的现状、影响因素进行详细分析，并基于史密斯政策执行过程模型视角，以点推面，从理想化政策、执行主体、目标群体和环境因素四方面进行执行困境分析，探究执行过程中面临的问题与障碍等。再而立足于宏观、中观、微观多维度提出优化路径，以期为智慧医保的进一步完善升级提供参考，赋能智慧医保的高质量发展。
Under the contribution of the national development strategy, Zhejiang Province actively responded to the development goal of intelligent medical insurance, and named the province’s unified access to the national medical insurance information platform and iterative optimisation and upgrading as the “intelligent medical insurance” project, of which Hangzhou has become the largest city in the province in terms of the number of medical participants and the “two fixed” institutions with the largest daily settlement volume and the most detailed information management measures. In this paper, from the perspective of the most widely used function of the public—medical insurance electronic certificate, we adopt a questionnaire survey to investigate the status of the development of intelligent medical insurance and the use of residents in Hangzhou, reflecting the current status of the implementation of the intelligent medical insurance policy and the satisfaction of the residents. Using a variety of statistical methods such as Columnar Analysis and Random Forest to analyse in detail the status quo and influencing factors of the implementation of intelligent medical insurance, and based on the perspective of Smith’s policy implementation process model, to push forward the implementation dilemmas from the perspective of a point-by-point approach, the idealised policy, the implementation subject, the target group and the environmental factors, to explore the problems and obstacles faced in the process of implementation, and so on. Based on the macro, meso and micro dimensions, the optimisation path is proposed, in order to provide reference for the further improvement and upgrading of intelligent medical insurance, and to empower the high-quality development of intelligent medical insurance.