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社区卫生改革中“医保预付制和收支两条线”政策的应用和推广,有助于从成本上约束和规范社区卫生服务机构的医疗服务提供行为,使其趋利倾向得以降低;但各国改革的实际经验显示,部分社区卫生服务提供方存在不合理检查、不合理治疗、不合理用药、不合理住院和不合理收费等行为,造成医疗资源的浪费和医疗保险费用的不合理使用,有悖于“医保预付制和收支两条线”政策的设计理念。本研究对国外及国内各地区社区卫生改革的做法进行了现状分析,并提出了相应的对策。
In the course of community health reform, the application and promotion of “two lines of medical insurance prepayments and receipts and payments” helps to constrain and standardize the provision of medical services by community health service institutions so as to reduce their propensity to profit. However, the actual experience of the reform in various countries shows that some community health service providers have unjust inspection, unreasonable treatment, unreasonable use of drugs, unreasonable hospitalization and unreasonable charges, resulting in the waste of medical resources and the unreasonable use of medical insurance fees , Contrary to the “Medicare advances and two lines of revenue and expenditure ” policy design. This research analyzes the current situation of the practices of community health reform both in foreign countries and in various regions of our country and puts forward corresponding countermeasures.