医疗费用不合理的快速增长与医疗服务的提供结构、医疗机构的运行机制密切相关。新医改以来,各级政府加强了对基层医疗服务机构的投入,基层医疗需求得到了一定保障,但城乡居民的就医选择并未明显出现从大医院流向基层医疗机构的转变,甚至出现了反向流动:门诊、特别是住院医疗服务进一步向高等级医院集中。新医改实施过程中,公立医院改革、药品流通体制改革(集中招标采购)虽然也有所推进,但并未根本改变医疗机构的管理 The rapid growth of unreasonable medical expenses is closely related to the provision of medical services and the operating mechanism of medical institutions. Since the new medical reform, all levels of government have stepped up their investment in grassroots medical service agencies and the demand for grassroots medical care has been guaranteed. However, the choice of medical care for urban and rural residents has not obviously changed from a major hospital to a grassroots medical institution, and even reversed Mobility: Outpatient clinics, particularly inpatient medical services, are further concentrated in high-grade hospitals. During the implementation of the new medical reform, although the reform of public hospitals and the reform of drug circulation system (centralized bidding and purchasing) have also been promoted, they have not fundamentally changed the management of medical institutions