保外就医制度是我国一项重要的刑罚执行制度，体现了“宽严相济”的刑事政策，它从人道主义出发，在尊重和保障罪犯基本的生命权和健康权的基础上，给予患病罪犯离开封闭的监管环境去社会接受治疗的机会，对于罪犯本人身体健康的保障、监狱的监管改造和社会的和谐稳定都具有重要的意义。但是，如果监狱在保外就医中“暗箱操作”、“纸面服刑”，违法违规保外就医，则会对司法公正和法律权威造成不良影响。

随着立法的修改和刑事政策的调整，导致保外就医在实践中被从严掌握，适用率比较低，加之当前监狱在押罪犯尤其是病残犯人数的增多，出现了大量病残犯不能被保外就医而留在监狱服刑，严重加剧了监狱的医疗负担，增加了监狱的监管压力。在行刑的两端，入口和出口之间并没有保持动态合理的平衡。此外，保外就医在制度和执行层面也存在一定的问题，在制度层面存在的问题有：部分法律条款操作性不强；对罪犯社会危险性评估没有统一标准，现有评估工具其科学性存疑；病情诊断环节存在鉴定费用承担主体不明确、疾病诊断检查医学文书不规范和医生等相关人员责任不明确问题；在病情复查环节，病情复查文书不规范，社区矫正工作人员未参与病情复查过程可能产生弄虚作假，“一保到底”的风险。在执行层面存在的问题有：保证人不履行保证义务时责任缺失，疾病鉴定时检察监督实质化程度不高以及对罪犯保外就医后的监督管理不到位。

就此，本文主要通过文献研究结合案例分析的方法，分析监狱保外就医工作中存在的问题，针对性地提出了完善监狱保外就医制度的对策建议。认为监狱在保外就医工作中应当秉持当前检察机关推行的少捕慎诉慎押理念，科学准确把握保外就医的制度要求，依法依规办理保外就医。应当加大监狱中心医院的建设力度，积极推进医疗资源社会化，将罪犯纳入社会居民医疗保险体系和社会救助体系，明确罪犯在社会保险体系中的主体地位，采取多种方式缓解监狱当前压力。要建立动态的《保外就医严重疾病范围》，构建科学合理的罪犯社会危险性评估体系。建议明确病情诊断费用的承担主体，制作统一的制式病情鉴定表、病情复查文书，进一步明确诊断人员的责任，以帮助伪造证据罪追究医师弄虚作假、违法违规诊断行为。对保证人不履行保证义务时，应当根据情节追究其责任。要强化检察机关对保外就医的实质监督，提高检察院检察监督的效力。建议在社区矫正机构工作人员中配备司法警察。

The medical parole system is an important penalty execution system in my country, which reflects the criminal policy of "combining mercy with strictness". It starts from humanitarianism, and on the basis of respecting and guaranteeing the criminals' basic rights to life and health, allows sick criminals to leave the confinement. It is of great significance to the protection of the criminal's own health, the supervision and reform of the prison, and the harmony and stability of the society.However, if prisons "operate behind the scenes" and "serve their sentences on paper" during medical parole, and seek medical parole in violation of laws and regulations, it will have a negative impact on judicial justice and legal authority.

With the revision of legislation and the adjustment of criminal policies, medical parole is strictly controlled in practice, and the application rate is relatively low. In addition, the number of prisoners in prisons, especially the sick and disabled prisoners, has increased, and a large number of sick and disabled prisoners cannot be granted medical parole. Staying in prison to serve a sentence seriously aggravates the medical burden of the prison and increases the supervision pressure of the prison. At both ends of the execution, there is no dynamic and reasonable balance between the entrance and the exit. In addition, there are certain problems in the system and implementation of medical parole.Problems at the institutional level include: Some legal clauses are not very operational; There is no uniform standard for assessing the social risk of criminals, and the scientific nature of the existing assessment tools is doubtful; In the process of disease diagnosis, there are problems that the subject of identification costs is not clear, the medical documents for disease diagnosis and examination are not standardized, and the responsibilities of doctors and other related personnel are not clear; In the disease review process, the disease review documents are not standardized, and the community correction staff who do not participate in the disease review process may lead to the risk of fraud and "one guarantee in the end". Problems at the implementation level include: When the guarantee fails to perform the guaranty obligation, the responsibility is lacking, the degree of substantive procuratorial supervision is not high when the disease is identified and the supervision and management of criminals after they are released on medical parole is not in place.

In this regard, this paper mainly analyzes the problems existing in the work of medical parole in prisons through literature research and case analysis, and puts forward countermeasures and suggestions for improving the system of medical parole in prisons.It is believed that prisons should adhere to the concept of fewer arrests, careful prosecution and careful detention, which is currently implemented by the procuratorial organs, in the work of medical parole, scientifically and accurately grasp the institutional requirements for medical parole, and handle medical parole in accordance with laws and regulations.The construction of prison central hospitals should be intensified, the socialization of medical resources should be actively promoted, criminals should be included in the social resident medical insurance system and social assistance system, the main role of criminals in the social insurance system should be clarified, and various methods should be adopted to alleviate the current pressure on prisons.It is necessary to establish a dynamic "Scope of Serious Diseases on Medical Parole", and build a scientific and reasonable social risk assessment system for criminals.It is recommended to clarify the subject of the cost of disease diagnosis, make a unified standard disease identification form and disease review documents, and further clarify the responsibilities of the diagnosing personnel, so as to help the crime of forging evidence to investigate the doctor for falsification and illegal diagnosis.When the guarantor fails to perform the guaranty obligation, the guarantor shall be investigated for its responsibility according to the circumstances.It is necessary to strengthen the substantive supervision of procuratorial organs on medical parole, and improve the effectiveness of procuratorial supervision by procuratorates. It is recommended to have judicial police among the staff of community corrections institutions.