“先诊治后结算”的门诊医保卡结算模式探索

Settlement pattern about medical insurance card of“settled after treatment”

目的:探索解决传统就诊模式重复交费问题,同时克服拖欠费用风险的门诊结算模式。方法:查阅文献,实地调查,研究传统门诊就诊交费模式和"预存就诊费用"交费模式的优劣势,指出这些交费模式存在的问题及实施的困难。结果:提出了一种门诊流程结算的新模式——医保卡冻结模式。结论:有效的门诊结算方式是提高医院门诊就诊效率的重要方式,是处理好医、患、保三方关系的重要保证。

Objective ： To solve the traditional pattern of repeated payment problems, while overcoming the ＂predeposited costs＂ risk among outpatient. Methods： Literature was reviewed and on scene research aimed at pros and cons of tradition outpatient payment mode and ＂pre-deposited visits fee＂, which raised these problems in payment patterns and implementation difficulties. Results： A new model for outpatient procedures--to freeze medicare card mode was proposed. Conclusion： Outpatient settlement effectively is an important way to improve hospital efficiency, which ensure a good relationship between medical personnel, patients, and insurance institutions