总量控制与个人付费相结合的费用控制机制的探索

To Set up and perfect the Controlling System of Medical Expenses, Deepen the Reform of the Medical Insurance System in China.

为了控制医疗费用不合理增长,确保医疗保险费用的收支平衡,建立和完善有中国特色的职工医疗保障制度,镇江市在5年医改实践中,探索形成了一套总量控制与个人自付相结合的医疗费用控制机制。为此,我们对这一机制的形成以及通过这一机制所产生的作用进行了总结和分析,旨在为我国正在进行的城镇职工医疗保险制度改革提供有益的借鉴。

In order to control the unconscionable increase in the medical insurance cost and set up the medical insruance system characteristic of China, we have basically made both ends meet in the medical insurance funds by establishing and making use of a cost controlling system that combines gross budget and individual expenditure sharing, on the basis of taking into account the benefits of the state, units, medical institutes and employees for 5 years in Zhenjiang, which is one of the first experinental and pioneer cities approved of by the State Council of China. We thus provided helpful inspiration and useful reference for the reform of medical insurance system that is being done in China.