论文部分内容阅读
由于原有的医疗保险管理中存在费用支付方式不合理、管理机制单一及管理措施执行不力等因素,对医疗费用控制没有实现预期目标,不能为患者提供制度性保护,不断提高的筹资率加重了企业的负担。通过研究,改革医疗保险管理机制,要从增强对供方的制约作用入手。文章提出了信用等级制度的理论框架,即在考核评价的基础上,确定定点医院的信用等级,向社会公布信用等级,以引导患者合理就医。实施信用等级制度,通过扩大影响范围、增加作用机制和拓展管理手段等,增强对定点医院的约束,有效控制医疗费用,但也存在医院通过转移费用等方式来弥补损失。文章还对实施信用等级制度的考核评价的指标体系和主要内容进行了介绍。
Due to the unreasonable payment methods, the single management mechanism and the poor implementation of management measures, the original medical insurance management failed to achieve the expected goal of medical expense control and could not provide institutional protection to patients. The ever-increasing funding rate has increased The burden on the business. Through researching and reforming the management mechanism of medical insurance, we should start from strengthening the restriction of suppliers. The article puts forward the theoretical framework of the credit rating system, that is, on the basis of assessment and appraisal, it determines the credit rating of designated hospitals and announces the credit rating to the society so as to guide the patients to seek reasonable medical treatment. The implementation of credit rating system, through the expansion of the scope of influence, increase the mechanism of action and expand management tools, to strengthen the constraints of designated hospitals, effective control of medical costs, but there are also hospitals to transfer costs and other ways to make up for losses. The article also introduces the index system and main contents of the appraisal and evaluation of the implementation of the credit rating system.