试论新形势下医院医改与医保的关系

通过对镇江市15年来探索实施和完善医疗保障制度改革运行情况的分析,从医保在医院运行中的地位、作用与影响,存在的主要矛盾、问题及对策与建议等方面阐述了公立医院、医改与医保三方的发展关系.提出医院与医保之间要在医改的大前提下协调发展;建立医院与医保之间平等协商的谈判机制;建立与医保能力相适应的受益标准;建立科学可行的费用结算和付费方式;医院必须深化改革、加强管理,承担为群众提供优质医疗服务和合理控制医疗费用的双重责任.

On the relationship among hospitals, healthcare reform and medical insurance

This paper analyzed the 15-year exploration and practice in Zhenjiang City on the reforms of the healthcare reform From the perspectives of the role and impact exerted by medical insurance in hospitals,as well as main challenges and countermeasures or recommendatioas of this regard,the paper discussed the development relationship among public hospitals,healthcare system reform and medical insurance.Main points include the following:orchestrated development between hospitals and medical insurance;establishment of an equal negotiation mechanism between hospitals and medical insurance;establishment of a beneficary system adaptable to medical insurance capacity;establishment of a scientific and feasible pattern of fees settlement and payment;hospitals are expected to deepen the reform and better management,playing the role of providing quality medical services and reasonably controlling medical costs.