定点医院推行医保体系化管理初探

Methods Realization of Carrying out Medical Insurance Systematic Management in Fixed Medical Organizations

医疗机构是实施医疗保障制度改革中的重要方,医疗机构在医疗行为中加强管理,对构建和谐医、保、患关系有着重要的现实意义。对定点医院推行的医保体系化管理机制,医保沟通体系、医保质量体系、医保服务体系、医保信息体系、医保文化体系等5个子体系对医保体系化管理具有重要作用。5个子体系既是5个独立的单元,也是整个医保管理体系的有机构成部分,只有这5个体系相互配合、共同发展,才能保证医保事业的稳步前进。

Medical organizations plays very important roles in the reform of medical insurance. To strengthen the management of the medical conducts is quite important for harmonizing the relationships among the patients, the hospitals and the insurance organizations.The management mechanisms of medical insurance system in designated hospitals have been discussed, and affirmed the role of health care com- munication system, quality health care system, health care service system, health care information systems and health careand cultural systems. The five sub-system is not only five independent units, but also constitute part of the entire medical insurance management system.Only the five systems complementing each other and common developing, can the cause of medical insurance maintain steady progress.