目的:通过对比分析东莞市医疗保险制度的优点和存在的主要问题,了解东莞市医疗保险参保人员医疗服务利用情况,为进一步完善医疗保险制度提供建议.方法:采用数据调查和深入访谈相结合的方法,对东莞市社会保障局相关数据系统进行研究数据采集,进行量性数据分析；并对利益攸关方进行访谈,做补充定性评价.结果:东莞市医疗保险参保人员医疗服务利用呈现逐年递增的趋势,医保制度为参保人员提供了良好的保障作用,医疗服务利用量在各级医疗机构的分配较合理.不足方面为医保覆盖范围较小、费用补偿机制不够完善、医疗机构职责定位不明确、三级医疗机构仍占据大部分医疗服务量等问题.结论:进一步扩大医疗保险覆盖范围,合理健全费用补偿机制,通过经济杠杆合理指导参保人员的就医行为,明确医保定点医疗机构职责,为东莞市医疗保险参保人员提供更好的医疗保障服务.%Objective: We aimed to understand the utilization of health service of residents under medical insurance in Dongguan city and discover strong points and shortcomings to provide the reference for further consummating the institution of medical insurance in Dongguan city. Methods: Data survey and in -depth interviews were used to investigate and appraise the utilized situation of health services of medical insurance in Dongguan city through data system of Dongguan social security department. Results: The utilization of health services of medical insurance insured in Dongguan city increases progressively year by year. The institution of medical insurance provides good protection for the insured people, and the quantity of medical services utilization has a reasonable distribution in medical institutions at all levels. However, there's still something that the Dongguan medical insurance need to be improved. For example, medical insurance coverage is small, medical cost compensation system is not perfect, the responsibility orientation of medical institutions is not clear, and the tertiary hospitals still occupy the most of the health services. Conclusion: In order to provide a better medical insurance service, we suggest that medical insurance coverage be further expanded, medical cost compensation system be better improved, the medical behaviors of the insured people be guided reasonably through the economic lever, and the responsibility of designated medical institutions be more clarified.
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