现有医保基金收支平衡制度难以解释基金结余严重与需求尚未满足的困境。本文基于制度演化的视角,探讨了医保基金从数量平衡到质量提升的演化机理。认为数量平衡原则是基于政府、社会、个体三种力量演化的结果,满足了财务可持续的要求;但随着主体力量的变化,制度设计从注重数量转向提升质量;为了实现更加可持续的医疗保障制度,必须同时满足财务可持续与政策可持续,即在数量平衡中嵌入权利、目标、需求等内容,实现“质、量”平衡的统一。 The existing medical insurance fund balance of payments system is difficult to explain the serious balance of funds and demand unfulfilled plight. Based on the perspective of institutional evolution, this article explores the evolution mechanism of Medicare funds from quantity balance to quality improvement. We think that the principle of quantity balance is based on the evolution of the three forces of government, society and individual, which meet the requirements of financial sustainability. However, with the change of subject strength, system design shifts from focus on quantity to quality improvement. In order to achieve more sustainable medical The guarantee system must meet the requirements of both financial sustainability and policy sustainability, ie embedding the rights, objectives and needs in the quantity balance so as to achieve the unification of the balance of quality and quantity.