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近年来,我国医疗保险制度不断发展完善,包括职工医保、城镇居民医保和新型农村合作医疗的参保人员已达90%以上。医院作为医保改革的最前沿,医疗保险制度改革的各项政策规定,只有通过医院的贯彻落实,才能传递给参保患者。如何在现行的医疗保险制度下完善参保人员、医保机构、医院三方之间的关系,做好医院医保精细化管理,已成为医院的重要工作。笔者拟就医保定点医院的管理实践和相关体会,讨论存在的难点,并提出相应的对策及建议。
In recent years, the medical insurance system in our country has been continuously developed and improved. The number of people insured for medical insurance for urban residents, urban residents, and new rural cooperative medical care has reached over 90%. Hospital as the forefront of health care reform, the medical insurance system reform policies and regulations, only through the hospital’s implementation, can be passed to insured patients. How to improve the relationship among the insureds, medical insurance agencies and hospitals under the current medical insurance system and how to finely manage the medical insurance in hospitals has become an important task for hospitals. I intend to seek medical treatment and hospital management practices and related experience, to discuss the existing difficulties, and put forward corresponding countermeasures and suggestions.