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本文简要回顾了建国后中国社会医疗保障制度建立与改革的发展历程,分析总结了中国城镇劳保、公费医疗制度与农村传统合作医疗制度走向解体的原因和经验教训。基于对医疗费用不合理膨胀成因的分析和认识,本文阐述了缺乏对不合理医疗行为有效管控是影响中国医疗保障体制改革成效的重要因素,并建议将强化医疗行为管控作为提高中国社会医疗保险保障成效的突破口,以此为基础,本文提出了对加强医疗行为风险管控的思路和建议。
This article briefly reviews the development history of the establishment and reform of China’s social medical security system after the founding of PRC and analyzes the reasons and experiences and lessons learned from the dissolution of China’s urban labor insurance, public health medical system and rural traditional cooperative medical system. Based on the analysis and understanding of the causes of the unreasonable inflation of medical expenses, this article elaborates that the lack of effective management and control of irrational medical behaviors is an important factor affecting the effectiveness of China’s medical insurance system reform. It is suggested that strengthening the management and control of medical behaviors should be taken as the guarantee for improving China’s social medical insurance Based on which, this paper puts forward the ideas and suggestions on strengthening the management and control of medical behavior risks.