医药服务是昂贵的消费品，医疗保障是通过国家、用人单位、个人等多渠道筹资建立专项基金和监督管理制度，分担参保患者的医药费用和补偿医药提供方的制度安排，其价值在于将医药服务从奢侈品转化为必需品，改善国民健康水平和促进医药产业发展。医疗保障做为第三方付费者，付费方式与监管模式紧密相关但理论总结不足。医疗保险制度建设初期注重“补需方”，以筹资和分担参保人医药费用为主采取事后监督。20世纪70年代以来先行发达国家基本实现“全覆盖、保基本”制度建设，面对医护需求上升、科技进步和人口老龄化带来的卫生支出增长，医保进入控制医疗成本与合理补偿医药机构的“补供方”阶段，均值打包付费方式促使医保走进医院，实现过程监控。2010年以来，医疗保障关注医疗服务质量、成本和健康绩效，需要医、患、保通力合作建立评价评估机制，探索“价值医疗”与综合治理。2018年以来，我国医保进入“建机制，促医改”综合治理，亟待理论化总结制度创新及核心机制。本研究对全球医疗保障监管的发展路径，我国医保医药协同、成本效益兼顾的综合治理机制的形成、作用机理和制度安排进行分析。通过文献研究、案例研究和定量分析相结合的方法，本研究发现：（1）首次以支付方式及其激励机制为视角总结了全球医保监管发展路径：“事后监督-过程监控-综合治理”。（2）结合全球和中国医保监管制度变迁与金华市医保综合治理案例，引入利益相关人、风险共担、激励相容、社会契约、剩余索取权等理论在协作治理分析中建构了以医保支付改革为推手的综合治理“风箱效应”模型，对实现“降点增值”和抑制“鼹鼠效应”的医疗保障基金长效平衡综合治理机制及其作用机理进行分析。最后，通过F市病组分值付费改革定量分析，验证了病组分值付费抑制过度医疗的初步效果和局限性。本研究的贡献如下：（1）在理论视角上，通过文献研究和理论归纳描述了全球医疗保障监管的发展路径，拓展了以线性时间下卫生系统改革为主流的医疗保障治理研究范式，提供了以医保支付约束-激励机制为核心的中观视角；（2）在理论贡献上，以“风箱效应”理论架构总结了中国医保支付改革和综合治理的理论和实践，揭示了中国式医保激励相容机制设计和综合治理机制的形成路径，为推进健康绩效评估和继续深化医保支付改革奠定了基础。（3）在研究数据上，获取了中国医保支付改革的一手数据和跟踪了综合治理的典型案例，弥补了现有医疗保障监管改革研究资料不充足的问题。

Medical services are expensive consumer goods. Public health insurance refers to the institutional arrangements for the establishment of special funds and supervision and management systems through multi-channel financing by the state, employers, individuals, etc., to share the medical expenses of insured patients and to compensate medical providers. Its value is the transformation of medical services from luxury to necessity, the improvement of national health and the development of the medical industry. As a third-party payer, health insurance is closely related to the mode of payment and supervision, but the theoretical summary is insufficient. In the early days of the health insurance system, the focus was on the "demand-side", with post-facto supervision based on financing and sharing the medical costs of the insured, and since the 1970s the developed countries have basically achieved a "full coverage, basic protection" system. In the face of rising demand for health care, technological advances and an ageing population, health insurance has focused on the "supply side", entering a phase of controlling medical costs and reasonably compensating medical institutions, and promoting the introduction of health insurance into hospitals by means of equal value packaged payments and process monitoring. Since 2010, health insurance has focused on the quality, cost and health performance of health care services, requiring the cooperation of health insurance, patients and healthcare providers to establish evaluation mechanisms and explore "value-based care" and integrated governance. Since 2018, China's health insurance has also entered into the integrated governance of "building mechanisms and promoting health care reform", and there is an urgent need for a theoretical analysis of its formation paths and mechanisms.This study finds that (1) for the first time, the path of global health insurance regulatory development is summarized through the lens of payment methods and their incentive mechanisms: "post-event supervision - process monitoring - integrated governance". (2) Combining the changes of global and Chinese health insurance regulatory systems with the case of Jinhua's comprehensive health insurance governance, the study introduces theories of stakeholder, risk sharing, incentive compatibility, social contract and residual claim in the collaborative governance analysis and constructs a model of the "wind box effect" of comprehensive governance with health insurance payment reform as the driving force, which has a significant impact on achieving The model is used to analyze the mechanism of long-term balanced comprehensive governance of the health insurance fund and its mechanism of action, which can achieve "value-added reduction" and suppress "mole effect". Finally, a quantitative analysis of the reform of value-based payment for patients in city F was conducted to verify the initial effects and limitations of value-based payment for patients in curbing excessive medical treatment.The contributions of this study are set out below.: (1) From a theoretical perspective, the development path of global public health insurance regulation is constructed through literature research and theoretical induction, and the research paradigm of medical security governance with the health system reform as the mainstream in linear time is expanded. (2) in terms of theoretical contribution, this paper summarizes the theory and practice of China's public health insurance payment reform and comprehensive governance with the theoretical framework of the "bellows effect", which helps promote health performance evaluation and continuous improvement. Deepening the reform of the public health insurance payment has laid the foundation, and revealed the design of the Chinese-style public health insurance "restraint-incentive" incentive compatibility mechanism and the formation path of the comprehensive governance mechanism. (3) In terms of research data, this study obtained first-hand data of China's public health insurance reform and tracked typical comprehensive management cases, which made up for the insufficient research data on the existing reform.