实现异地就医即时结算关键路径选择

The Choice of the Critical Path in Achieving National Medical Insurance Remote Immediate Settlement

异地就医只能限制在特定人员、特定病情,并通过特定手续,按特定政策结算。特定人员是指异地安置人员;特定病情是指因参保地医疗仪器设备条件或技术方面原因,必须转异地就医的病情;特定手续是指参保人员异地就医必须办理异地安置或转诊转院手续;特定结算政策,就是医疗费用支付标准和支付范围的上限绝不能高于参保地政策,必要时还应适当降低。

Remote medical service is limited to specific persons, particular diseases, and the account must be settled through specific procedure based on specific policy. The specific persons are defined as relocated persons;particular disease are defined as the ones which must be treated remotely since the limitation of medical devices or technologies in local place; specific procedure means the insured person must be a relocated person, must go through referral procedure or transfer procedure. For the specific settlement policy, it indicates that the standard of payment and the upper bound should not exceed these of local ones, and it can be reduced when it is necessary.