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随着医疗保险制度改革的不断深入,医保覆盖面日益扩大,参保受益的人越来越多,但一些深层次的矛盾和问题也不断凸现,已严重影响到医保基金的安全运行。本文从胜利油田定点医疗机构管理角度入手,针对基本医疗保险运行过程中的基金的跑、冒、滴、漏现象,提出了定点医疗机构管理中存在的难点问题,并就如何完善和加强对定点医疗机构的监督管理,提高医疗保险管理服务水平,规范医疗机构行为和杜绝医疗保险基金的流失等方面进行了认真的分析思考,提出了具体可探性解决方法。
With the continuous deepening of the reform of the medical insurance system, the coverage of medical insurance has expanded and more and more people have benefited from the insurance. However, some deep-seated conflicts and problems have also been highlighted, which has seriously affected the safe operation of the medical insurance fund. This article starts from the perspective of the management of fixed point medical institutions in Shengli Oilfield, and proposes the difficult problems in the management of fixed-point medical institutions in response to the running, risking, dripping, and leaking of funds during the operation of basic medical insurance, and how to improve and strengthen the fixed point. Supervision and management of medical institutions, improving the level of medical insurance management services, standardizing the behavior of medical institutions, and eliminating the loss of medical insurance funds have carried out serious analysis and thinking, and put forward concrete and exploratory solutions.