乳山市职工医保门诊慢病基金管理的做法和体会

Practice and Experience of Outpatient Chronic Disease Medical Insurance Fund Management for the Employees in Rushan

乳山市不断探索加强门诊慢病基金管理的有效办法,严格准入和申报制度、加强对定点医疗机构的管理、实行患慢病职工的动态管理,取得了较好效果。针对存在问题,作者建议:严格审批和报销程序,加强稽核;提高预防意识,降低门诊慢病发病率,尽可能规避基金支付风险。

An effective way to manage the outpatient chronic disease medical insurance fund has been continually explored in Rushan. The methods of strict permission and application system, rigorous administration of the assigned institutions, dynamic management of outpatients suffering from chronic disease have brought a good result. To deal with present problems, the author suggests that the procedure for approval and reimbursement should be strict to enhance account checking; the sense of preventing the occurrence of chronic disease to decrease the expenditure of insurance fund should be emphasized.