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南京医科大学学报（社会科学版）京医科大学学报（社会科学版）
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Journal of Nanjing Medical University（Social Sciences）of Nanjing Medical University（Social Sciences） 2026年10月
Journal
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［17］ 王红波，张开然，龚曦. 县域医共体与医保的协同发 （本文编辑：姜 鑫）

Measurement and improvement path analysis of synergy degree of

healthcare⁃medical insurance integrated systems

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2
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2
Ma Nan ，Yin Xuefeng ，Bai Junwen ，Shen Zhanlei ，Miao Yudong 2
1. Human Resources Department（Postdoctoral Research Station），Henan Academy of Innovations in Medical Science，Zhengzhou
450003；2. College of Public Health，Zhengzhou University，Zhengzhou 450001；3. Beijing Research Association for Chronic
Diseases Control and Health Education，Beijing 100021，China
Abstract：To promote the coordinated development and governance between China’s healthcare and
medical insurance systems，this paper constructs an order parameter indicator system for the two systems based
on the synergetics theory. Adopting a cross⁃system analysis method，it establishes a measurement model for the
healthcare⁃medical insurance integrated system，and calculates the order degrees of the healthcare system and
the medical insurance system，as well as the synergy degree of the compound system from 2003 to 2023. The
results indicate that the development of China’s healthcare and medical insurance systems developed largely in
isolation during this period，with the synergy degree fluctuating at a persistently low level ranging from -0.097
to 0.099， showing a significant scissors gap （asymmetric） evolution characteristic. This paper suggests
establishing mechanisms for sharing high ⁃ quality healthcare resources based on integrated delivery systems
（IDS），while using differentiated performance assessments to mitigate the siphoning effect of large hospitals.
Furthermore，it is necessary to further reform the medical insurance payment systems toward a diversified，

integrated model featuring DRG/DIP，consolidate the global budget and surplus retention mechanism，while
deeply aligning them with the hierarchical medical system. Furthermore，it is vital to establish a regular cross⁃
departmental coordination mechanism for collaboration among healthcare， medical insurance and
pharmaceuticals with a foundational data⁃sharing platform. The synergy degree of the integrated system should
be incorporated into a routine monitoring framework to build a dynamically adaptive closed ⁃ loop governance
system.
Key words：healthcare system；medical insurance system；synergy degree model；collaborative governance