跨省门诊慢特病直接结算存在问题与对策研究——以苏州市S医院为例
Research on the problems and countermeasures of direct settlement for chronic and special critical dis-eases in cross provincial outpatient service——taking suzhou S hospital as an example
纪正 1周倩1
作者信息
- 1. 苏州大学附属第二医院 江苏苏州 215004
- 折叠
摘要
目的 探究跨省门慢特直接结算政策实施现状及存在问题,提出改进对策和建议,为进一步完善跨省门慢特直接结算政策提供参考,提升患者就医满意度和便捷性,共同维护医保基金安全.方法 提取S医院跨省门慢特结算数据和医保服务平台数据,收集并梳理日常结算中遇到的困难,分析政策实施存在的问题及原因.结果 跨省门慢特直接结算给患者带来了便利,结算人次日益增多,但仍存在结算流程繁琐、结算人次不高、部分病种无法结算、患者不清楚结算政策、开通医疗机构数量不多及结算数据不准确等问题.结论 各级医保部门和医疗机构需共同努力,制定统一门慢特目录、扩大试点病种和医疗机构覆盖范围、优化结算流程、加强信息化建设、加强政策宣传和人员培训力度、建立异地门慢特结算监管机制.
Abstract
Objective To explore the current implementation status and existing problems of direct settlement for chronic and special critical diseases in cross provincial outpatient service policies,propose improvement strategies and suggestions,pro-vide reference for further improving direct settlement for chronic and special critical diseases in cross provincial outpatient service policies,enhance patient satisfaction and convenience in seeking medical treatment,and jointly maintain the safety of medical in-surance funds.Methods Extract settlement data from chronic and special critical diseases in cross provincial outpatient service and medical insurance service platform data from S Hospital,collect and sort out the difficulties encountered in daily settlement,and analyze the problems and reasons in the implementation of settlement policies.Results Direct settlement for chronic and special critical diseases in cross provincial outpatient service has brought convenience to patients,with an increasing number of settlement personnel.However,there are still problems such as cumbersome settlement processes,low settlement personnel,ina-bility to settle certain diseases,unclear settlement policies for patients,limited number of medical institutions opened,and inac-curate settlement data.Conclusion Medical insurance departments and institutions at all levels need to work together to develop a unified list of outpatient treatment for chronic and special critical diseases,expand the scope of pilot diseases and medical insti-tutions,optimize settlement processes,strengthen information construction,strengthen policy promotion and personnel training,establish a regulatory mechanism of outpatient treatment for chronic and special critical diseases in remote locations.
关键词
跨省异地就医/门诊慢特病/直接结算/医保管理Key words
Trans-provincial and remote medical treatment/Outpatient treatment for chronic and special critical disea-ses/Direct settlement/Medical insurance management引用本文复制引用
出版年
2023
国家科技期刊平台
NSTL
万方数据