德国社会医疗保险改革在世界范围内产生了深远影响。本文从组织体制变革的视角对德国医疗保险制度的产生、发展和改革历程进行了回顾,在此基础上分析德国社会医疗保险组织体制模式选择的决定因素和制度变革的驱动机制,并对其总体绩效和改革效果进行初步评价。本文认为,德国社会医疗保险制度改革正朝着“管理式竞争”的方向在发展,这是其在价值理念、物质环境以及政治体制等变动下自我调整的结果。总体而言,这一改革始终坚持着团结互助的基本理念,并赋予了国民更多的自由选择权,充分保证了制度的公平性,但在如何提高制度的有效性方面仍然需要继续努力。 German social health insurance reform has had a profound impact worldwide. This article reviews the birth, development and reform process of the German medical insurance system from the perspective of the organizational system reform. On this basis, it analyzes the determinants of the institutional choice of the social medical insurance system in Germany and the driving mechanism of institutional change. Performance and reform of the initial evaluation. This paper argues that the reform of the social medical insurance system in Germany is moving toward the direction of “management competition”, which is the result of self-adjustment under the changes of values, material environment and political system. Overall, this reform has always adhered to the basic concept of solidarity and mutual assistance, and has given its citizens more freedom of choice, which has fully guaranteed the fairness of the system. However, it still needs to continue its efforts in improving the effectiveness of the system.