摘要
自门诊统筹政策实施以来,各地均对该制度开展了不同程度的探索,然而尚未形成较为系统完善的一套门诊统筹模式。文章通过针对参保患者的调查问卷、针对医院工作人员的座谈访谈以及对现有文献理论的总结归纳,发现影响该制度发展的因素主要包括:医疗服务能力有限、政策宣传力度不足、待遇水平与费用分担机制缺乏公平性以及信息系统应急机制匮乏。基于此,文章提出了提升医疗机构服务能力,满足患者差异化需求;加大政策宣传力度,稳定提高用户粘性;合理确定待遇水平,切实减轻就医经济负担;完善门诊统筹信息系统,提升门诊费用报销效率等建议。
Since the implementation of the outpatient co-ordination policy, various regions have explored the system to varying degrees, but a more systematic and perfect outpatient co-ordination model has not been formed. Through questionnaires for insured patients, interviews with hospital staff and summary of existing literature and theories, the paper finds that the main factors affecting the development of the system include: insufficient capacity of community health services, inadequate policy publicity, lack of fairness of treatment level and cost-sharing mechanism, and lack of emergency mechanism of information system. Based on this, the article puts forward the following suggestions: improving the service capacity of medical institutions to meet the differentiated needs of patients;strengthening policy propaganda to stabilize the stickiness of users;reasonably determining the level of treatment, effectively reducing the financial burden of medical treatment;improving the overall outpatient information system, and improving the efficiency of reimbursement.
出处
《保险职业学院学报》
2019年第2期30-33,共4页
Journal of Insurance Professional College
关键词
城乡居民基本医疗保险
门诊统筹
优化路径
Basic medical insurance for urban and rural residents
Outpatient co-ordination
Optimization path
