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医疗保险制度改革是建立有中国特色社会保障体制的重点和难点。由于医疗行为涉及医、药、患、保四方,利益相互交错,一直以来,如何协调各方关系,控制医疗费用,合理配置卫生资源,提高国民健康状况成为困绕制度创新者的难题。广西平南县根据自身实际情况,本着“系统管理,防治并举”的原则,历时五年,探索出一条“分层控制,循环投入”的医疗保险新路子,并取得很好的实践效果。本文拟在对平南模式进行概括性介绍的基础上,从理论和实践两个层面对筹资机制、保障内涵、费用控制机制等医疗保险制度的核心问题进行深入的探讨。
The reform of the medical insurance system is the key and difficult point in establishing a social security system with Chinese characteristics. As medical practices involve medicine, medicine, patients and patients, the interests are mutually intertwined. How to coordinate the relations among all parties, control medical expenses, rationally allocate health resources and improve the national health have always become difficult problems for institutional innovators. Based on its own actual conditions and based on the principle of “system management, prevention and control simultaneously”, Pingnan County of Guangxi Province lasted five years and explored a new way of medical insurance with “stratified control and recycling” and achieved good practical results. Based on the general introduction of Pingnan model, this paper discusses in depth the core issues of the medical insurance system such as financing mechanism, content of guarantee, cost control mechanism and so on from two aspects of theory and practice.