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以全国著名专科医院为例,探讨其在医疗保险试点到全覆盖进程中如何建立有效的内部医保管理和异地医保管理部门的主动沟通机制,从而较好地解决了异地、尤其是边远地区医保患者的看病难问题,稳固推进医院的可持续发展,同时很好地解决了异地医保管理的难题——抑制医保欺诈行为。并根据作者近10年的工作体会,提出多条建议,希望能就该方面工作今后如何可持续良性循环开展与同行共同讨论。
Taking the famous specialized hospitals in China as an example, this paper explores how to establish an effective internal medical insurance management system and an active communication mechanism with the medical insurance management departments in different places during the pilot coverage of medical insurance so as to better solve the problems of medical insurance patients in remote places, especially in remote areas Of the difficult to see a doctor, and firmly promote the sustainable development of the hospital, but also a good solution to the problem of remote health care management - inhibiting health insurance fraud. According to the author’s work experience in the past 10 years, he put forward many proposals and hoped to discuss with colleagues on how to carry out a sustainable and virtuous circle in this aspect in the future.