下面是小编为大家整理的医院医保办对异地医保结算战略 医保局异地就医结算工作运行情况调研报告,供大家参考。
中国卫生产业
CHINA HEALTH
INDUSTRY
从2000年开始,医疗保险的工作就逐渐的全面化,从较少的试点到社会的广泛推广,医疗费用的报销制度由单位制定过渡到由相关管理部门的社会统筹。这样一个措施在一定程度上减轻了大部分投保人员的医疗花费,但是一旦面临当地的医疗水平无法满足患者的需要时,或者患者因为异地居住、异地工作等原因无法在当地规划范围内进行诊疗的情况时,由于医疗保险的管理部门并没有建立起完善的异地医疗制度,巨大转诊医疗费用给部分的患者带来了经济压力。许多患者就是因为这样的原因无法得到有效的医疗保护导致错过了最佳救助时期。因此异地医保已经成为当今社会的一个趋势,异地医保的结算问题也成为了社会的重点关注问题。
1医院医保办对异地医保结算的做法1.1重视异地医保
异地医保的建设和完善不仅仅是一个医院的职责和义务,同时对以后的医疗系统的进一步优化和医保系统的管理都有着重大的意义,所以医院首先应该重视异地医保的建设工作。
1.2构建好与异地医保部门沟通的桥梁
要想能逐渐建立异地医保的系统,与异地医保部门的联系是必须的,需要异地医保部门的一系列帮助,只有双方共同努力,才可以构建出较为完善且合理的制度。
1.2.1调研异地患者的信息①调查异地患者的分布情况:河北省占54.56%,黑龙江、山西、河南、山东、吉林等
DOI:10.16659/http://www.wendangku.net/doc/3b311ec3d25abe23482fb4daa58da0116c171f9c.html ki.1672-5654.2017.26.103
医院医保办对异地医保结算的战略
张娜
中国医学科学院肿瘤医院,北京
100021
[摘要]异地就医是指那些已经对基本医疗保险已经投保的人员,由于工作、旅游、转诊等原因所导致的在参保所归属地区以外的医疗机构进行就医或是购买药品的行为。异地医保结算是各个不同的医疗规划区域通过机构委托的方式进行联网结算,或者是通过和不同于本地的医疗结构合作的方式,从而达到就医人员的医疗保险费用报销效果,使异地医疗的水平得到充分的保障。近年来,由于人口的流动率和人们的医疗保险意识不断的提高,就造成异地就医的需求率大大增加,但另一方面,面临的问题也逐渐增多。国务院等相关机构也提出一系列的实施方案来不断改善并完善异地医保结算的机制。
[关键词]医保办;异地;医保结算[中图分类号]R197
[文献标识码]A
[文章编号]1672-5654(2017)09(b)-0103-02
Strategy of Hospital Medical Insurance Office for Medical Insurance Settle⁃ment in Off-site
ZHANG Na
Tumor Hospital of Chinese Academy of Medical Sciences,Beijing,100021China
[Abstract]Off-site medical treatment refers to a group of people who have been insured on the basic medical insurance,due to work,travel,referral and other reasons caused by the insured in the area outside the medical institutions for medical treatment or purchase of drugs.Outside the medical insurance settlement is a network settlement of different medical plan⁃
ning area through the agency or through cooperation with different medical structure,so as to achieve medical insurance re⁃
imbursement effect of medical treatment,so that the level of remote medical treatment can be guaranteed.In recent years,due to the population turnover rate and the improvement of people’s awareness of medical insurance,a large increase in de⁃mand for medical treatment off-site,but on the other hand the problems were gradually increasing.The State Council and other relevant agencies had also proposed a series of implementation programs to continuously improve the mechanism of off-site medical insurance settlement.
[Key words]Medical insurance office;Off-site;Medical insurance settlement
[作者简介]张娜(1977-),女,北京人,硕士,经济师。
103
http://www.wendangku.net/doc/3b311ec3d25abe23482fb4daa58da0116c171f9c.html . All Rights Reserved.
推荐访问:医保局异地就医结算工作运行情况调研报告 医保 异地 结算