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目的分析参保患者非理性就医现象,积极探索应对策略,为控制不合理增长的医疗费用提供参考。方法结合我院医保工作中对医保基金正确合理使用的管理及参保患者的就医情况,分析近年来参保患者非理性就医的现象、原因及结果,探索应对策略,总结规范化管理的措施。结果小病大治、大病贵治、无病保养等是非理性就医的主要表现,严重影响医保费用的管理,助推了过度医疗和医疗费用的不合理增长。结论应落实国家医药卫生体制改革,完善配套的医疗保险政策,深化医院医保费用管理,科学控制基本医疗付费总额,控制医疗费用不合理增长,从而保障医保基金的安全使用。
Objective To analyze the phenomenon of irrational medical treatment in insured patients and to explore coping strategies actively so as to provide reference for controlling medical expenses with unreasonable growth. Methods Based on the management of the Medicare fund in the medical insurance work in our hospital and the medical treatment of the insured patients, this paper analyzes the phenomena, reasons and results of the irrational medical care in recent years, explores coping strategies and summarizes the measures of standardized management. The results of ailments disease, serious illness expensive rule, disease-free maintenance is the main manifestation of irrational medical treatment, seriously affecting the management of medical insurance costs, boosting excessive medical and medical expenses unreasonable growth. Conclusion It is necessary to implement the national medical and health system reform, improve the matching medical insurance policy, deepen the management of hospital medical expenses, scientifically control the total payment of basic medical services and control the unreasonable increase of medical expenses so as to ensure the safe use of medical insurance funds.