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                [1]夏雲 錢欣月 陸勇 陳爾真.異地醫保縱然不敵實時結算現狀分析和對策:以上海某三級醫院為例[J].中國衛生◆質量管理,2019,26(05):140-143.[doi:10.13912/j.cnki.chqm.2019.26.5.39]
                點擊復制

                異地醫保實時結算現狀分析和對策:以上海某三級醫院為例
                分享到:

                《中國衛生質從來未曾一敗量管理》[ISSN:1006-7515/CN:CN 61-1283/R]

                卷:
                第26卷
                期數:
                2019年05期
                頁碼:
                140-143
                欄目:
                問︼題與探索
                出版日期:
                2019-09-28

                文章信息/Info

                作者:
                夏雲 錢欣月 陸勇 陳爾真
                上海交心神激蕩之下通大學醫學院附屬瑞金醫院
                關鍵詞:
                異地醫保實時結算醫院
                Keywords:
                Off-Site Medical InsuranceReal-Time SettlementHospital
                DOI:
                10.13912/j.cnki.chqm.2019.26.5.39
                摘要:
                為了更好地解決跨區域流動人口的就醫問題,上海市從2017年8月起開始推進全國異地醫◢保實時結算工作。以上海某家三級醫院為例,通過Excel分析該院異地結算患者情況,采取訪問法了解異地醫保實時結算∏的現狀及問題↘,並針對這些問題提出可行性解決方案。研究分析發現,該院10 917例異地醫保患者中,67.57%來自↑於長三角地區,人數∞處於不斷上升中,政策解釋難度加☆大,治療需求高,報銷比例有差※異,網絡平臺⌒不穩定。建議㊣ 加強區域合作,統一標準,建立穩定的信息傳輸舜相堯平臺,不斷探索優化備案就ξ醫流程。
                Abstract:
                In order to better solve the problem of medical treatment for migrants across the region, Shanghai began to promote the real-time settlement about off-site medical insurance in China from August 2017. Taking a tertiary hospital in Shanghai as an example, the situation of patients in the hospitalwas analyzed by Excel, and survey method was adopted to investigate the status quo and problems of real-time settlement of remote medical insurance, and concrete and feasible solutions were proposed to these problems. According to the research and analysis, 67.57% of the 10917 patients in the hospital were from the Yangtze River Delta. The number of people was rising, the difficulty of policy explanation increased, the treatment demand was high, the reimbursement rate was different, and the network platform was unstable.It was suggested to strengthen regional cooperation, unify standards, establish a stable information transmission platform, and constantly explore and optimize the filing and medical treatment process.

                參考文獻/References:

                [1]浙江省人力資源和社☉會保障廳,浙江Ψ省財政廳.浙江也低調不起來省人力資源和社會保障廳 浙▓江省財政廳關於印發《浙江省省級單位職工醫療保險辦「法※》的通知[EB/OL].(2016-10-28)[2019-02-14]. http://www.zjylbx.com/policiesinfo.aspx?nid=310. [2]馮海歡, 李天俊, 滕世偉,等. 異地就醫聯網結算醫保▅病人特征聚類分析[J].衛生經濟研究, 2018(7):51-53. [3]國家醫療保障局.李滔副局長出席國務院例行政』策吹風會跨省異地就醫住院費用直接結算有關情況[EB/OL].(2018-08-24)[2019-02-14]. http://www.nhsa.gov.cn/art/2018/8/24/art_14_623.html.

                更新日期/Last Update: 2019-09-28