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我省城镇职工基本医疗保险制度运行一年以来总体平稳,医疗费用增长过快的势头基本得到遏制;医疗资源的有效利用率有所提高;职工基本医疗得到有效保障,初步达到了医疗保障制度改革的目的。但一些定点医疗机构仍存在医疗行为上的不规范,如在药品消费上用药档次高、量大、超指征用药(如几种抗菌素同时使用,在手术前后普遍使用高档次抗菌素进行预防感染,病人出院带了较大量的与本次住院无关的常用药物),不必要或重复进行临床检查、化验等。出现人均住院医疗费用逐月较快上涨的现象,造成卫生资源不必要的浪费,加大医保统筹基金的支出,加重了参保患者个人负担,因此需要强化对定点医疗机构医疗行为的监督控制,以保证医保基金的正常运转。
The basic medical insurance system for urban workers in our province has been generally stable in the past year and the trend of excessive growth in medical expenses has been basically checked; the effective utilization rate of medical resources has been raised; the basic medical insurance for workers and staff has been effectively guaranteed and the medical insurance system reform has been initially reached the goal of. However, some designated medical institutions still have irregular medical behaviors. For example, high drug consumption, high dosage and super-indications medicine (such as the simultaneous use of several antibiotics, the use of high-grade antibiotics before and after surgery to prevent infection, Patients discharged with a larger amount of commonly used drugs unrelated to this hospital), unnecessary or repeated clinical examination, laboratory tests. There is a phenomenon that the cost of hospitalization per capita is rapidly rising month by month, resulting in unnecessary waste of health resources, increasing the expenditure of medical insurance co-ordination funds and increasing the individual burden of insured patients. Therefore, it is necessary to strengthen the supervision and control over the medical behaviors of designated medical institutions, To ensure the normal operation of health insurance fund.