以医疗行为管控为路径提高社会医疗保险成效探析

Strengthening management of medical practices as the breakthrough for enhancing the effectiveness of social medical insurance system

本文简要回顾了建国后中国社会医疗保障制度建立与改革的发展历程,分析总结了中国城镇劳保、公费医疗制度与农村传统合作医疗制度走向解体的原因和经验教训。基于对医疗费用不合理膨胀成因的分析和认识,本文阐述了缺乏对不合理医疗行为有效管控是影响中国医疗保障体制改革成效的重要因素,并建议将强化医疗行为管控作为提高中国社会医疗保险保障成效的突破口,以此为基础,本文提出了对加强医疗行为风险管控的思路和建议。

Tthe paper reviewed the history of establishment and reform of China＇s social medical insurance system, and analyzed the reasons why the urban labor-protection medical care system ,free medical services and rural traditional medical cooperative system had failed. Based on the analysis of irrational inflation of medical expenses, the paper elaborated that the lack of risk control and management for unreasonable medical practices affected the effect of China＇s medical insurance system reform,and therefore suggested that enhancing the medical practices management should be the breakthrough for improving the effectiveness of China＇s social medical insurance system. The paper offered suggestions on how to improve the risk management of medical practices.