民营医院医保服务状况及对策建议——以扬州市区民营医院为例

The Status of Private Hospitals’ Medical Insurance Service and Suggestions——A Case from Yangzhou City

民营医院的发展壮大可以弥补政府在医疗卫生方面投入的不足,竞争机制的引入有利于打破公立医院一统天下的格局,给各地医疗服务市场注入新的活力,也为广大群众提供了更多的就医选择。但是,民营医院的逐利本性,致使其在医疗服务中难以严格遵守医保政策,骗套医保基金的现象时有发生。因此,强化对民营医院的监督管理,规范其医疗行为,遏制医疗费用的不合理增长,是当前医保经办管理面临的一个重要课题。

Development and expansion of private hospitals can make up the whole medical and health resources which government investment is not enough. The introduction of competition will help break the domination of public hospitals, energize the medical services market, and provide more selection for patients. However, because of the profit-driven nature, it is difficult for private hospitals to comply with medical insurance policy strictly, and cheating phenomenon often occurrs. Therefore, strengthening the supervision and management of private hospitals, standardizing their medical practices, and curbing unreasonable increase on medical expenses, are important issues faced in the management of medical insurance currently.