陕西省医疗保险经办机构服务能力现状分析

The situation analysis of the management and services abilities of health insurance administrative agencies in Shanxi province

通过对陕西省105家医疗保险经办机构进行的普查,对医疗保险经办机构基本业务开展状况、经办机构基金收缴率、财政基金欠款情况、业务管理成本、信息化建设、基本医疗保险覆盖面、管理方式等方面的现状进行分析,发现陕西省医疗保险经办机构管理服务中存在着诸如机构设置混乱、经办人员工作量大、政府财政支持不足、信息化水平低等问题,并据此提出要明确医疗保险经办机构法律地位、提高政府部门支持力度和重视程度、加强信息化建设、规范管理方式、加强相应理论研究等政策建议。

Through investigating the 105 health insurance administrative agencies in Shanxi province, this pa- per conducts a situation analysis of the status of Health Insurance Administrative Agencies, including the basic busi- ness conditions, the collection rate for institutional fund managers , financial situation of the Fund outstanding, business management costs, information technology construction, basic health insurance coverage, and managerial modes. It finds that the issues of lacking of unified standard disordered arrangement of insurance administrative agencies, administrative staff＇s too much work, low recognition of health insurance administrative agencies by government, poor financial support, and low level of using information technology. Basing on research findings, it recommends ensuring the legal status of health insurane agencies, increasing government depatrments support and strengthening the information technology, standardizing management, and strengthening the theoretical research.