江苏响水县是财政补贴县,收支常常不能平衡,近年来由于公费医疗费迅猛增长,财政更趋困难。我们认为公费医疗经费支出迅猛增长的原因,主要是管理上的问题,对此,从1989年元月份起,实行由财政直接管理的尝试,收到明显效果,1～6月,支出总额由上年同期的34.3万元减少到27.6万元,下降19.5%,人均支出由上年同期的58元减少到46.8元,下降19.3%。主要做法是: 一、变多头管理为财政一家管理。过去,财政部门,卫生部门、专职公费医疗机捣、医疗单位都参与管理,但分工不明,职责不清,配合松散,缺 Xiangshui County, Jiangsu Province, is a county subsidized by the government. The balance of payments often can not be balanced. In recent years, due to the rapid growth of medical expenses at public expense, it becomes more difficult for the government to finance it. In our opinion, the main reason for the rapid growth in public expenditure on medical expenses is management. For this reason, from January 1989 onwards, direct financial management efforts have yielded noticeable results. From January to June, the total expenditure was increased from The figure of 343,000 yuan in the same period decreased to 276,000 yuan, a decrease of 19.5%. Per capita expenditure decreased from 58 yuan in the same period of last year to 46.8 yuan, down by 19.3%. The main approach is: First, a long change management for the financial management. In the past, financial departments, health departments, full-time public medical institutions and medical institutions were all involved in the management. However, the division of labor was unclear, their responsibilities were unclear, and they were loosely matched and lacking