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目的:通过对医疗保险管理实践经验的介绍,探索医院医保管理方法。方法:采用实地调研获取数据、文献搜索整合观点。结果:医疗保险管理存在种类多,机构分散,服务意识不强,统筹款支付周期过长,拒付严重,不能满足实际需要等问题。结论:提出创新医保管理机制、整合医疗保险经办机构和信息系统、增强医疗保险管理机构服务意识、实行医保基金实行专户管理、推进医保支付方式改革的建议。
Objective: To explore the management methods of hospital medical insurance by introducing the experience of medical insurance management. Methods: Field research to obtain data, literature search integration point of view. Results: There are many problems in medical insurance management, such as many kinds of management, decentralized organization, weak service awareness, long pay period of fund-raising, serious protest and unable to meet the actual needs. Conclusion: It is proposed to innovate medical insurance management mechanism, integrate medical insurance agency and information system, enhance the service consciousness of medical insurance management institution, implement special account management of medical insurance fund and promote the reform of medical insurance payment method.