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控制医疗保险费用,是医疗保险改革的重点和难点。1994年开始的统帐 结合的医改试点,由于改革处于起步阶段,费用控制制度设计不够成 熟,职工对费用控制意识淡薄,加之改革的外部环境不配套,费用不合理上涨没有得到有效控制。 费用控制的难点 (一)个人帐户的激励和约束功能未能充分发挥,统帐结合的模式尚未定位。 (二)基本医疗保险范围和水平尚未严格界定,费用控制的“度”难以把握。 (三)医疗保险费用的偿付方式不合理,第三方付款的后付制引起过度的医疗需求。 (四)对医疗服务机构的补偿有限,医疗服务机构控制费用的积极性受到限制。 有效控制费用的对策 (一)从需方看,一方面要放开一块,由市场调节发挥作用;另一方面要提高参保人的就医成本,增强患者的费用意识。医疗保险的需方是医疗保险的直接
Control of medical insurance costs, medical insurance reform is the focus and difficulty. Since the reform was in its infancy, the cost control system was not yet mature enough in design. The staffs’ awareness of cost control was weak. In addition, the reform external environment was not matched and the unreasonable increase in costs was not effectively controlled. Difficulties in cost control (A) the incentive and restraint of individual accounts failed to give full play to the combination of reorganization and accounting has not yet been set. (B) the scope and level of basic medical insurance has not been strictly defined, the cost control of the “degree” is difficult to grasp. (C) the payment of medical insurance costs unreasonable, third-party payment of post-payment system caused by excessive medical needs. (4) Compensation for medical service agencies is limited, and the enthusiasm of medical service agencies in controlling costs is limited. Measures to effectively control costs (A) from the demand side, on the one hand to be liberalized by the market regulation to play a role; the other hand, to increase the insured person’s medical costs and enhance patient awareness of costs. Demand side of health insurance is direct medical insurance