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正在实施的医疗保险制度改革,主要是解决城镇职工基本医疗需求,亦即提供基本医疗保障。考虑到国家、企业和职工的经济承受能力,保障水平既不能超越经济发展水平,又要满足参保职工的基本医疗需求。如何解决医疗保险这一难题,关键是寻求医疗供需之间适宜的激励机制,以此激励供方加强成本控制和预防保健,提供适宜的医疗技术和服务,同时促使劳动者确立个人健康投入意识,合理控制卫生服务需求,共同实现卫生资源的有效利用,最终目的是提高医疗保险基金的使用效率,保障职工身心健康。一、以医疗需求为导向,以竞争为动力,加强对卫生资源的有效调控,形成布局合理、优质高效的卫生服务体系。限于计划经济条件下的医疗管理体制和运行机制,医疗机构之间缺乏竞争和协作,大、小医院的定位、模式差别不大,而患者普遍存有求优心理,趋向于去大医院就诊。
The reform of the medical insurance system being implemented is mainly aimed at solving the basic medical needs of urban workers, that is, providing basic medical insurance. Taking into account the economic affordability of the state, enterprises, and employees, the level of protection can neither exceed the level of economic development but also meet the basic medical needs of the insured employees. The key to solving the problem of medical insurance is to seek appropriate incentive mechanisms between medical supply and demand, so as to motivate suppliers to strengthen cost control and preventative care, provide appropriate medical technology and services, and at the same time encourage laborers to establish personal health input awareness. Rationally control the demand for health services and jointly realize the effective use of health resources. The ultimate goal is to increase the efficiency of the use of medical insurance funds and ensure the physical and mental health of employees. First, with medical demand as the direction, and with competition as the driving force, we must strengthen the effective regulation and control of health resources and form a rational, high-quality, and efficient health service system. Confined to the medical management system and operation mechanism under the planned economy, there is a lack of competition and collaboration among medical institutions, and the positioning and mode of large and small hospitals are not much different. Patients generally have the psychology of seeking excellence and tend to go to large hospitals for treatment.