医疗制度和费用控制共同作用于居民健康权利的落实与维护,需要政府和农民主体性参与。政府、农民二维主体参与决定了合作医疗各阶段的不同表现和医疗费用控制的不同模式,据此,医疗费用控制模式可以划分为疏导式、疏通式、无力式、受限式和围堵式五种。通过模式间比较可以发现,费控模式具有逻辑起点的同一性、政府定位的基础性、模式差异的同源性、费控框架的一致性和费控自主性的依赖性特征,凸显了政府绝对主导的时代特征。然而,忽略市场与社会影响的农村合作医疗,费用控制势必难以在后续发展中形成制度保障。因此,农村医疗费用的控制必须处理好政府、市场与社会、农民三维张力在农村医疗保险制度之间的关系,致力于培育政府的社会公平性与公益性、市场与社会功能的补充性、农民行为选择的自主性等,形成对传统合作医疗政府、农民二维状态的突破,保障农村社会医疗保险制度的可持续发展。 The medical system and cost control act together on the implementation and maintenance of residents’ health rights, which requires the government and peasants to participate in the project. The two-dimensional main body of the government and peasants participate in the decision-making of the different stages of the performance of different forms of cooperation and medical costs control different modes, therefore, the medical cost control mode can be divided into diverting, dredging, weak, restricted and containment Five kinds. Through the comparison between the modes, it can be found that the fee-for-control model has the logical starting point of identity, the basis of government orientation, the homology of the pattern differences, the consistency of the fee-charging framework and the dependence of the expense-control autonomy, Leading characteristics of the times. However, neglected the market and social impact of rural cooperative medical care, cost control will inevitably be formed in the subsequent development of institutional guarantees. Therefore, the control of rural medical expenses must handle the relationship between government, market and society, the three-dimensional tension of farmers in the rural medical insurance system, and devote themselves to fostering the government’s social fairness and public welfare, the complementarity of market and social functions, farmers The autonomy of behavior selection and so on, forming a breakthrough in the two-dimensional state of traditional cooperative medical care and peasants and ensuring the sustainable development of the rural social medical insurance system.