摘要
目的探讨降低门诊医疗保险拒付率的对策，规范医疗保险患者诊疗环境。方法通过分析解放军总医院第一附属医院2012年6—7月55241张门诊医疗保险处方中部分拒付的原因，之后采取处方审核点评及通过处方联络单与医生建立沟通平台等整改措施规范医疗保险处方，分析比较整改前后的处方拒付情况。结果通过加强药师的处方审核力度，采取处方联络单整改措施后，门诊处方拒付比例显著下降，门诊医疗保险拒付总例数由整改前107人次（0．19％）下降到19人次（0．03％），差异有统计学意义（P〈0．05）。结论拒付主要体现在超量开药项目上；强化药师在改善医疗保险处方拒付中的作用，可显著减少门诊医疗保险处方拒付的发生。
Objective To analyze the reasons of protest of outpatient medical insurance prescription and to investigate the countermeasures to reduce the protest rates. Methods By analyzing the reasons of protest of outpa- tient medical insurance prescription of the First Affiliated Hospital of Chinese Peoples Liberation Army General Hos- pital from June to Junly 2012, the medical insurance prescription were regulated by the communication platform of prescription contact list between pharmacists and doctors after taking prescription audit review; the protest instances before and after prescription audit were analyzed and compared. Results By strengthening the prescription audit and contact list, the protest proportion of outpatient prescription decreased significantly, and total number of cases were reduced from 107 cases （0. 19%） to 19 cases （0. 03%） with statistical significance （P 〈 0. 05）. Conclusion The excessive prescribing is mainly protest project; pharmacists can significantly reduce the occur- rence of prescription protest in outpatients.
出处
《中国医药》
2013年第11期1639-1640,共2页
China Medicine
关键词
门诊药师
医疗保险拒付
处理对策
Outpatient pharmacist
Protest in medical insurance
Countermeasures
