控制医药费用不合理增长是城镇医疗保障制度改革的目标之一。该文采用病历回顾的方法 ,选取急性阑尾炎和住院分娩两种健康状况作为指示病例 ,分析了不同医疗保险改革模式与医药费用变化的关系。基本结论是 ,医疗保障制度改革与医药费用控制关系密切 ,医疗保障制度是影响医药费用水平的主要因素 ,在尚未完全建立新型的医疗保险模式的地区 ,两个病种的医药费用攀升速度较快 ,费用上升速度总体上是实施新型医疗保险比较成熟地区的一倍多。医疗保障制度改革方案的合理设计和有效实施对于控制医药费用过快增长意义重大 The unreasonable increase in the control of medical expenses is one of the goals of the reform of the urban medical security system. In this paper, medical history review is used to select two kinds of health conditions, acute appendicitis and hospital delivery, as indicator cases. The relationship between different medical insurance reform models and changes in medical costs is analyzed. The basic conclusion is that the reform of the medical security system is closely related to the control of medical expenses, and the medical security system is the main factor affecting the level of medical expenses. In areas where the new type of medical insurance has not yet been fully established, the medical costs of the two diseases are climbing faster. The overall rate of increase in costs is more than double that of the more mature regions where new medical insurance is implemented. The rational design and effective implementation of the reform plan for the medical security system is of great significance for controlling the excessive growth of medical expenses