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处方开药量在医政及医保管理都有相关的规定,但在临床工作中仍面临诸多未能详尽阐明的问题。医疗保险处于费用控制需要,对10种特殊疾病做出了可开出不超过1个月的可操作的具体规定,但多年未进一步进行疾病增补和完善。同时,由于医保在控制费用中片面强调单次开药量的网络审核和控制,卫生行政部门又疏于医疗行为的监控,给患者、医师和医院管理都带来一系列的现实难题。面对目前医保资源的不合理消耗及药品使用的不规范现象,医保和医政管理应做好顶层设计,从基本医保药品目录管理以及医师和参保人医疗行为规范等方面入手,加强对患者个体异常费用整体监控,注重临床医师的职业素养和道德规范教育,医政和医保分工合作,各司其职,才能真正合理高效的利用好医保资源,合理施治,实现医、患、保三方共赢。
Prescription prescribed quantity in the medical and health care management has the relevant provisions, but in clinical work is still facing many problems that can not be elaborated. Medical insurance is under cost control. Specific rules on 10 special diseases that can be carried out for no more than one month are provided. However, no further additions and improvements have been made to the disease over the years. At the same time, due to the medical insurance in the control of the cost of a single emphasis on the opening of a single examination of the amount of network audit and control, health administrative departments and neglect of medical behavior monitoring, patients, physicians and hospital management has brought a series of practical problems. In the face of the unreasonable consumption of medical insurance resources and the non-standardization of drug use, medical insurance and medical administration should make the top-level design. From the aspects of catalog management of basic medical insurance and medical and behavioral norms of doctors and insured persons, Individual monitoring of abnormal costs, focusing on clinical professional ethics and moral education, medical and health care division of labor cooperation, their respective duties, in order to truly and reasonably efficient use of health insurance resources, the rational administration, the realization of medicine, suffering, insurance tripartite total win.