实现“质量医保”的关键在医保管理

To Strengthen Medical Insurance Management is the Key to Achieve High-quality Medical Insurance

"质量医保"的质量是广义质量的概念。实现"质量医保"的关键在医保管理。医保管理要从忙于被动付费、关注单个医疗服务必要性、关注单个过程费用合理性的旧模式,转变到强化医疗服务监管、关注整体医疗服务有效性、关注群体医疗服务性价比的新模式上来。

To strengthen medical insurance management is the key to achieve high-quality medical insurance. The old management model, which is busy with settling accounts passively, paying attention to the necessary of the single medical service and the rationality of the single medical service expenditure, should be transferred to the new one which emphasizes on the supervision to medical service, the whole validity of medical service and the cost performance of group medical service.