广元医保监管的三赢效益解析

A Interpretation for the Tri-win Super vision of Guangyuan Medical Insurance

对医疗保险定点医疗机构、定点药店实行招标准入和末位淘汰,已有9家医院、8家药店被淘汰;医保付费总额、住院费用起付标准等实行差别化管理,执行医保协议优秀的,付费总额就高,反之就低,2013年与2012年比较,增加总额的医院31家,增加总额2255万元,总额持平的医院9家,减少总额的医院5家,减少总额62万元;鼓励社会监督举报医疗违规,已兑现举报奖励资金45万元……这些创新性的机制实施后,定点医院、药店严于自律的意识空前增强,医疗费用得到合理控制,医保基金使用效率和医疗服务质量提升,参保群众得到实惠。

After the policy of bidding access and last grade elimination has been implemented to the designated medical institutions and pharmacies, 9 hospital and 8 pharmacies are eliminated. According to this policy, the total payment of medical insurance and basic payment standard of hospitalization cost should be managed discriminatingly, which means that the institutions perfectly implement the protocol shall get a higher total payment of medical insurance, and vice versa. Comparing the data of 2013 and 2012, 31 institutions got a higher total payment, with a increased payment of 22.55 million RMB, while there are 9 institutions＇ payment not changed and 5 reduced with an total amount of 0.62 million RMB. The policy also encourage the social supervision of medical violation, with a cashed reward of 0.45 million RMB. Since the implementation of the novel policy, the self-discipline of the designated institutions was strengthened and the medical expenditure was properly regulated. The increased efficiency of medical insurance funds and the enhanced quality of medical services will bring benefit to the policyholder.