门诊医疗保险实时结算运行问题分析

Analysis on running problems in medical insurance real-time settlement in outpatient department

分析了门诊医疗保险实时结算实施后出现的问题，探讨了医保定点医院面临的医保经办机构管理更加严格、信息准确性要求提高、医保拒付费用显著增加、医生执业环境严峻等形势，提出了严格规范医生医疗行为、升级改造医院信息系统、增加人员配备、挖掘医院潜力、全面宣传医保就医新政等管理策略。

Analyze the problems of medical insurance real-time settlement in outpatient department. Explore the situation of stringent management of health medical insurance agencies, accuracy of the information, significant increasing costs that medical insurance agencies refused to pay and severe environment to doctors. And management strategy such as regulating doctors＇ behavior strictly, upgrading hospital information systems, increasing hospital staff to excavate the hospital potential and publicizing the new policy of medical insurance comprehensively.