医疗体制改革与社会医疗保险基金合理利用原则的研究

The Studies on Health Care System Reform and the Principle of Rational Use of Social Health insurance

中国医疗体制改革是社会主义经济体制改革的重要部分。中国的公费和劳保医疗制度为保障人民健康 ,做出了巨大的贡献。然而 ,4 0多年的实践证明 ,这种公费医疗体制不适合社会主义市场经济体制改革的趋势 ,所以导致了一系列的问题 ,如 :医疗费用激增 ,医疗服务质量下降 ,医疗机构配置不合理 ,以及医疗资源的浪费等。本文在医疗保险基金的筹资—利用系统中 ,分析了改革试点各种统账方式的利弊。在了解了医疗基金的性质、特征及支付管理内容的基础上 ,探讨了中国医疗保险基金支付方式的原则 ,分析了总额预付制在现阶段实施的可行性 。

Health care system makes up an important part in China's social economic reform. Public health service and labor insurance has contributed much to ensuring people's health over the past years. However, it has also proved that this practice can not go with the current socialist market economic reform, and consequent problems are inevitable, such as: increasing cost in medical treatment, unsatisfied health care service, unreasonable distribution of medical facilities, and waste of medical resources, etc. By using the health care fund raising-using model, this study tries to find out advantages and disadvantages of different medical insurance systems, discuss the principle of payment by better understanding of medical insurance, its character and feature, and payment management. It finally analyzes the possibility of total pre payment in current stage.