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本文系统回顾了美国医疗保险的历史与现状及其发展的特点,并详细介绍了与医疗保险密切相关的医疗保健服务方式,即统筹医疗服务。(或管理保健Managed Care)全文从该模式发展的原因与组织形式,管理结构,医疗服务合同,医疗费用控制和经营管理方式等十一个方面,阐述了美国医疗保险与医疗保健服务协调发展的特点与趋势。尽管在我国全面借鉴这一模式尚不现实,但其控制医疗费用的措施和技术,医疗服务的管理体制与经营方式是可以为我国的社会医疗保险制度和城镇医疗保障体制的改革提供一些有借鉴意义的思路。
This article systematically reviews the history and current status of the U.S. medical insurance and its development characteristics, and details the health care services closely related to medical insurance, that is, the overall medical service. (Or Managed Care) The article elaborates on the coordinated development of US medical insurance and healthcare services in terms of the reasons for the development of the model, organizational structure, management structure, medical service contracts, medical expense control and management methods Features and trends. Although it is impractical to draw lessons from this model in our country, the measures and technologies for controlling medical expenses, the management system and management mode of medical services can provide some references for the reform of social medical insurance system and urban medical security system in our country. Meaning of the idea.