【摘要】 文章从政策和卫生服务利用两个方面 ,对职工医疗保险改革进行分析。改革提高了卫生服务筹资和居民健康保障的社会化程度 ,增加了个人卫生投入 ,树立了参保者的费用意识 ,对遏止卫生服务费用的快速上涨起到了积极作用。但个人帐户和统筹基金的分配比例不尽合理 ,客观上也抑制了居民的卫生服务利用 ,且对卫生服务供方的管理与监督缺乏有效的措施。建议建立医疗保险事务管理机构 ,加强供需双方的管理与监督 ,促进卫生服务的合理利用 ,变抑制需求为调节需求更多还原

【Abstract】 In the two aspects of health policy and resident’s health service utilization, analysis of urban health insurance reform had identifies that the reform improved the socialization of health service financing and health care scheme. It also increased individual health investment and established insurant’s sense of cost, which played an active role at decreasing rapid rising of health expense. However, the ratio of individual account and risk-sharing pooling fund is not proper according to the health expenditure ratio of outpatient and inpatient service, which objectively restricted insurant’s health service use. The scheme is also lack of effective measures to control and supervise behavior of contracted hospitals. Authors suggest establishing an administrative agency to deal with health insurance affair, which will enhance management of health service provider and users and improve the rational utilization of health service, to achieve a transformation of the scheme from restriction of health service demand to adjustment of that.更多还原