医院医保管理现状调查分析

INVESTIGATION AND ANALYSIS OF HOSPITAL MEDICAL INSURANCE MANAGEMENT PRESENT SITUATION AND ITS COUNTERMEASURES

医疗保险制度实施后,医保定点医院的医保管理工作关系到医、保、患三方的共同利益,在医院管理中越显突出,针对医保管理中的重点,对天津市4家医院的医务人员、住院患者进行问卷和实地访谈分析,了解到医患两组人群对医院医保管理的要求,提出了医务人员在医疗过程中的主要困境、医院内部管理的不协调因素、患者医疗费偏高、医院信息化建设四项问题现状和患者就医期间的满意度排列,将具体问题做深层原因的剖析。对政府主管部门就加强监管机制、建立指标体系制度、杜绝医患利益驱动行为提出四项建议和对策,以求达到引导医院全面提升医保管理的目的。

After implementing the medical insurance system, medical insurance designated hospitals in medi- cal insurance management work related to medical, security and patients with the common interests of three parties, it has been more and more prominent in the hospital management. Carry out a questionnaire and on - the - spot inter- view in hospital medical staff and inpatients of 4 hospitals of Tianjing city, aimed at the focus of insurance manage-ment to understand the insurance management requirements of the two groups people, put forward the main puzzledom of medical staff met in the medical process, the out of line factors in hospital internal management, patient＇s medical cost on the high side, the information construction of hospital, analyze the current situation of these 4 problems and its arrangement in patient＇s satisfactory, so that make a deep layer analysis of the concrete issues. Propose 4 suggestions and countermeasures for the government departments to strengthen supervision mechanism, to establish index system, to stop the doctor -patient interests driving behavior system in order to achieve improvement of the hospital medical insurance management objective.