在“个人账户管门诊,统筹基金管住院”的社会医疗保险模式并实行按项目付费的情况下,参保人员住院费用的变动对于统筹基金的平衡运行至关重要。笔者连续3年对湖南省长沙市的医保动态进行观察,结果发现长沙市(市本级)参保人员住院费和相关情况,存在过度提供医疗服务的现象,主要表现在住院费持续较快地上涨和就医集中在高级别医院这两方面。这些现象造成了医 In the case of “individual account management, co-financing hospital management” and the social-medical insurance model, and the implementation of project-based payments, the change in the hospitalization expenses of the insured personnel is crucial for the balanced operation of the integrated funds. For the third consecutive year, the author observed the dynamics of health care in Changsha, Hunan Province, and found that the hospitalization fees and related conditions of Changsha City (city-level) insured personnel over-provisioned medical services, mainly because the hospitalization fee continued to increase rapidly. Rising and medical attention are concentrated in high-level hospitals. These phenomena caused the medical