摘要
随着医疗体制改革的不断推进和医保支付方式的动态调整,医院医保管理面临着一系列挑战。各家医院为适应新医改的严峻形势,同时为进一步规范医院医疗服务行为,提高医疗保障基金使用效率,确保老百姓的“救命钱”用到实处,重庆大学附属肿瘤医院率先启动“医务-医保-财务”联动模式,从医疗行为监管、运行指标管控等方面建立健全机制,从信息需求、管理多元化等方面优化医保管理流程,确保三联动工作常态化、制度化,切实解决医院医保政策执行中存在的合理医疗、合理收费等问题,促进医疗与医保的协调作用,助推医院高质量发展,该模式在院内得到大力推广。本文提出提高医院医保管理质量的对策,希望能够促进医院医保管理工作改革,更好地做好医保工作,为患者服务。
With the continuous advancement of medical system reform and the dynamic adjustment of medical insurance payment methods,hospital medical insurance management is facing a series of challenges.In order to adapt to the severe situation of the new medical reform,each hospital will further standardize the medical service behavior of hospitals,improve the efficiency of the use of medical security funds,and ensure that the"life-saving money"of the common people is put to practical use.Cancer Hospital Affiliated to Chongqing University took the lead in launching the"Medical-Insurance-Finance"linkage model,established a sound mechanism from the aspects of medical behavior supervision and operation index control,etc.,and optimized the medical insurance management process from the aspects of information demand and management diversification,ensuring the normalization and institutionalization of the three-linkage work,effectively solving the problems of reasonable medical treatment and reasonable charges in the implementation of the hospital medical insurance policy,promoting the coordination between medical care and medical insurance,and boosting the high-quality development of the hospital.This model has been vigorously promoted in the hospital.In this paper,we also put forward some countermeasures to improve the quality of hospital medical insurance management,hoping to promote the reform of hospital medical insurance management work,better do medical insurance work,and serve patients.
作者
周艳红
黄晶
李杰
赵玉兰
ZHOU Yanhong;HUANG Jing;LI Jie;ZHAO Yulan(Department of Medical Insurance,Cancer Hospital Affiliated to Chongqing University,Chongqing,400030 China)
出处
《中国卫生产业》
2022年第11期223-225,233,共4页
China Health Industry
基金
2021年度重庆市沙区科协智库调研课题(2021SPBKXKT30)。
关键词
医务-医保-财务
医疗与医保
高质量发展
Medical-insurance-finance
Medical and insurance
High-quality development
