基本医疗保险异地就医管理服务研究——以江苏某三甲综合医院为例
|
摘要
城镇化进程中人口流动催生了异地就医行为,本研究结合医保日常管理工作,梳理了当前异地就医管理服务机制的现状,分析了异地就医管理服务机制中存在的患者对异地就医政策的知晓度不高,医保政策的差异性制约异地就医管理服务,异地就医服务的管理成本大、难度高等问题。提出了进一步加强异地就医政策的宣传工作,健全沟通机制、简化相应的异地就医备案手续,完善异地就医信息系统、提升医保异地就医结算效率等对策建议,以期逐渐完善异地就医管理服务,进一步提升异地就医患者的满意度。
In the process of urbanization,the migration of population led to the behavior of seeking remote medical treatment. This paper combines daily management of medical insurance,teases current status of the management and service mechanism of remote medical treatment,and analyzes the problems and reasons of the management and service mechanism of remote medical treatment,mainly including patients' low awareness of remote medical treatment policy,the differences of remote medical insurance policy restrict remote medical treatment management,large management cost and high difficulty of remote medical service. The study puts forward several suggestions,such as further strengthen publicity of remote medical treatment policy,sound communication mechanism,simplify the corresponding procedures of filing formalities for remote medical treatment,perfect remote medical treatment information system to improve the settlement efficiency of remote medical treatment.The study hopes to gradually improve the management services of remote medical,and further enhance the satisfaction of remote medical treatment patients.
In the process of urbanization,the migration of population led to the behavior of seeking remote medical treatment. This paper combines daily management of medical insurance,teases current status of the management and service mechanism of remote medical treatment,and analyzes the problems and reasons of the management and service mechanism of remote medical treatment,mainly including patients' low awareness of remote medical treatment policy,the differences of remote medical insurance policy restrict remote medical treatment management,large management cost and high difficulty of remote medical service. The study puts forward several suggestions,such as further strengthen publicity of remote medical treatment policy,sound communication mechanism,simplify the corresponding procedures of filing formalities for remote medical treatment,perfect remote medical treatment information system to improve the settlement efficiency of remote medical treatment.The study hopes to gradually improve the management services of remote medical,and further enhance the satisfaction of remote medical treatment patients.
引文
[1]何运臻,冯旅帆,侯志远.欧盟跨境就医管理模式对中国跨省异地就医的经验借鉴[J].中国卫生政策研究,2018,11(1):13-20.
[2]方鹏骞,陈婷.我国异地就医实时结算的问题、实现路径和趋势[J].中国卫生经济,2017,36(12):22-24.
[3]梁力中,陈铭扬.某地区医疗保险异地就医即时结算状况分析———以广东医科大学附属医院为例[J].卫生软科学,2017,31(11):42-44.
[4]刘伊凡,代涛,刘硕,等.以农村居民为例的京津冀地区人口异地就医结报现状与问题研究[J].中国医药导报,2017,14(7):154-158.
[5]赵斌.完善医疗保险异地就医管理服务机制研究[J].中国劳动,2016,67(4):55-62.
[6]王晶锐,蒋明红,赵歆妍.城乡医保一体化视角下异地就医问题探析[J].中国医疗保险,2015,6(2):20-22.
[7]刘玮玮,贾洪波.基本医疗保险中异地就医管理研究[J].中国卫生经济,2011,30(6):15-17.
[8]陈利芳.我国医疗保险异地结算的制度优化探讨[J].重庆交通大学学报(社会科学版),2017,17(5):88-92.
[9]杨莉华,王玉梅,宋敏.省内异地就医联网结算存在问题及对策措施[J].实用医药杂志,2018,35(1):91-93.
[10]王水莲,韩朝升.农村村民对城乡居民医保报销认知及使用现状分析[J].卫生软科学,2017,31(5):43-46.
[11]谢莉琴,陈庆锟,胡红濮.我国基本医保制度异地就医相关问题研究进展及启示[J].中国医院管理,2018,38(6):25-27.
[12]夏韡,张晓,仝晶晶.江苏省异地就医现状分析及对策研究[J].中国医院管理,2009,29(4):58-60.
[13]郑先平,刘雅,傅强辉.社会医疗保险异地结算问题及对策探讨[J].中国卫生经济,2015,34(2):25-27.
[14]刘芬菲,张有芳,周晓容,等.四川省内异地就医即时结算现状及改进建议[J].卫生经济研究,2018,(3):14-16,20.
[15]汪书怡,刘宝.基本医疗保险异地就医结算和管理的思考[J].中国卫生资源,2018,21(4):346-350.
[16]郭娜,焦卫平.从异地医保病案核查浅谈异地就医管理[J].中国病案,2017,18(11):19-22.
[17]陈婷,白雪,方鹏骞.基本医疗保险异地就医政策设计探讨:基于全国21省份政策的比较[J].中国卫生经济,2017,34(12):25-27.
[18]冯海欢,李天俊,滕世伟,等.异地就医联网结算医保病人特征聚类分析[J].卫生经济研究,2018,(7):51-53.
[19]李常印,高旭光.跨省异地就医推进的问题及对策[J].中国人力资源社会保障,2018,10(2):22-24.
[20]严翻,马国栋,潘建军,等.某市居民对统筹城乡居民基本医疗保险后满意度调查[J].卫生软科学,2018,32(1):39-41.
[2]方鹏骞,陈婷.我国异地就医实时结算的问题、实现路径和趋势[J].中国卫生经济,2017,36(12):22-24.
[3]梁力中,陈铭扬.某地区医疗保险异地就医即时结算状况分析———以广东医科大学附属医院为例[J].卫生软科学,2017,31(11):42-44.
[4]刘伊凡,代涛,刘硕,等.以农村居民为例的京津冀地区人口异地就医结报现状与问题研究[J].中国医药导报,2017,14(7):154-158.
[5]赵斌.完善医疗保险异地就医管理服务机制研究[J].中国劳动,2016,67(4):55-62.
[6]王晶锐,蒋明红,赵歆妍.城乡医保一体化视角下异地就医问题探析[J].中国医疗保险,2015,6(2):20-22.
[7]刘玮玮,贾洪波.基本医疗保险中异地就医管理研究[J].中国卫生经济,2011,30(6):15-17.
[8]陈利芳.我国医疗保险异地结算的制度优化探讨[J].重庆交通大学学报(社会科学版),2017,17(5):88-92.
[9]杨莉华,王玉梅,宋敏.省内异地就医联网结算存在问题及对策措施[J].实用医药杂志,2018,35(1):91-93.
[10]王水莲,韩朝升.农村村民对城乡居民医保报销认知及使用现状分析[J].卫生软科学,2017,31(5):43-46.
[11]谢莉琴,陈庆锟,胡红濮.我国基本医保制度异地就医相关问题研究进展及启示[J].中国医院管理,2018,38(6):25-27.
[12]夏韡,张晓,仝晶晶.江苏省异地就医现状分析及对策研究[J].中国医院管理,2009,29(4):58-60.
[13]郑先平,刘雅,傅强辉.社会医疗保险异地结算问题及对策探讨[J].中国卫生经济,2015,34(2):25-27.
[14]刘芬菲,张有芳,周晓容,等.四川省内异地就医即时结算现状及改进建议[J].卫生经济研究,2018,(3):14-16,20.
[15]汪书怡,刘宝.基本医疗保险异地就医结算和管理的思考[J].中国卫生资源,2018,21(4):346-350.
[16]郭娜,焦卫平.从异地医保病案核查浅谈异地就医管理[J].中国病案,2017,18(11):19-22.
[17]陈婷,白雪,方鹏骞.基本医疗保险异地就医政策设计探讨:基于全国21省份政策的比较[J].中国卫生经济,2017,34(12):25-27.
[18]冯海欢,李天俊,滕世伟,等.异地就医联网结算医保病人特征聚类分析[J].卫生经济研究,2018,(7):51-53.
[19]李常印,高旭光.跨省异地就医推进的问题及对策[J].中国人力资源社会保障,2018,10(2):22-24.
[20]严翻,马国栋,潘建军,等.某市居民对统筹城乡居民基本医疗保险后满意度调查[J].卫生软科学,2018,32(1):39-41.