国务院在推进医药卫生体制改革中多次强调,在建立分级医疗中要发挥医保的杠杆作用,促进参保人员充分利用基层社区医疗服务,提高医疗资源的利用效率。相关部门甚至委责医疗保险部门应当制定强制参保人首先到社区就医的规定。理论上讲,医保的杠杆作用,在分级医疗体制的建立中应当起决定性的作用。但需要几个给定的前提条件。第一,医疗服务资源必须是市场化配置,特别是最为核心的医师资源配置,要根据需 In its efforts to promote the reform of the medical and health system, the State Council has repeatedly emphasized that it is necessary to give full play to the leverage of health insurance in the establishment of graded medical care so as to promote the full utilization of grassroots community medical services and increase the utilization efficiency of medical resources. The relevant department or even the department in charge of the medical insurance shall formulate the stipulations on forcing the insured person to go to the community for medical treatment first. In theory, the leverage of Medicare should play a decisive role in the establishment of a hierarchical medical system. But requires a few given preconditions. First, the medical service resources must be market-oriented, especially the most central one.