对四川省泸州市医保协议管理工作的思考

Reflection on the Management Work of Medical Insurance Agreement in Luzhou,Sichuan

医疗保险管理中心通过与定点医院签订服务协议,做好医保服务、费用结算、管理考核等工作,实现对医院的规范管理,从而控制医疗费用的不合理增长,维持基金平衡。本文论述了协议的双重法律性质及其对管理关系的影响,描述了四川省泸州市医保协议的管理现状,分析其存在的突出问题;最后提出从树立"管理即是服务"的理念、做实精细化管理、不断提高监管能力三个方面来构建"严管、互利"的协议管理格局。

By signing service agreement with the designated hospitals, medical insurance management center should offer medical insurance services, expense settlement, management assessment, and so on. Thus hospital＇s standard management can be achieved, unreasonable growth in medical expenses can be controlled, and fund balance can be maintained. Based on the narration of the dual nature of the agreement and its influence on the management relationship, the description of the current situation of medical insurance management in Luzhou city of Sichuan Province, and the analysis on the existing prominent problems, this paper argues that we should construct a＂strict control and mutual benefit＂management pattern from the following three aspects： setting up the idea of＂management means service＂; implementing refined management; and improving the regulation ability continuously.