摘要
目的:分析和总结我国医保门诊慢性病在配套体系(包括医保经办服务体系和医保监督管理体系)方面的制度设计,为完善我国医保门诊慢性病政策提供参考,期望对优化我国医保经办服务体系、完善医保监督管理体系提供相关的政策建议。方法:查阅并总结基本医疗保险门诊慢性病相关政策内容,对其现状及存在的问题进行分析。结果与结论:我国大部分地区均在医保门诊慢性病配套体系上制定了相关政策,在实践过程中出现的问题主要涉及患者的资格审查、医疗机构的医疗服务管理和医保部门的基金监管三个方面。建议我国进一步完善患者资格审查机制,不断提高定点医疗机构管理水平,完善医保基金监管设计,促进门慢制度有效实施,规范管理。
Objective:To provide the references for policy making on outpatient chronic diseases of basic medical insurances in China by analysing and summarizing the design and framework of the supporting system,including the medical insurance service system and the medical insurance supervision and management system.Methods:The relevant policy of outpatient chronic diseases of basic medical insurances were reviewed and summarized,and the present situation and existing problems were analyzed.Results and conclusions:Most areas in China have formulated relevant policies in the supporting system of outpatient chronic diseases of basic medical insurances.There are three main problems involved in the practice of outpatient chronic disease policy of China's basic medical insurance,including qualifi cation examination of patients,medical service management of medical institutions and fund management of medical insurance departments.It is suggested to coordinate the use of diff erent medical insurance handling methods,give full play to the role of designated medical institutions,make full use of the Internet,so as to promote the eff ective implementation of outpatient chronic diseases of basic medical insurances and standardize management.
作者
姚雯
颜建周
邵蓉
Yao Wen;Yan Jianzhou;Shao Rong(National Drug Policy and Medical Industry Economy Research Center,China Pharmaceutical University,Nanjing,211198)
出处
《中国医疗保险》
2021年第10期24-29,共6页
China Health Insurance
基金
国家社会科学基金重大项目(No.15ZDB167)。
关键词
基本医疗保险门诊慢性病
经办服务
监督管理
outpatient chronic diseases of basic medical insurances
operating services
supervision and management
