医院医保支付现状探讨

The Payment Status of Hospital Medical Insurance

目的：探讨我市三级医院医疗保险支付方式的现状,为合理制定相关卫生政策提供参考。方法：通过对2010-2013年市三级医院医疗保险支付情况和经济运行情况的调研和系统分析,了解今年来市大型公立医院总额预付制度运行的相关情况。结果：近年来全市医保覆盖率不断攀升,而每年总额预付额度上涨幅度不明显,医保基金拒付情况严重,预付额度核算方式欠科学。结论：在更好满足医保患者就诊质量的同时,需进一步完善总额预付核算方式,加强医保管理,减少医院的经济负担。

Objective： In order to provide the reference for drawing up health policy,we discuss the the current situation of the third level hospital medical insurance payment. Methods： The methods that we can know about the system of rental payment in advance of third level hospital medical insurance pay- ment,by means of analysing the Medical insurance payment situation and the situation of economic operation between 2010 and 2012.Results： the result is the coverage rate of health care rises quickly In recent year.but Annual total prepaid amount rises is not obvious, Medical insurance fund of refusal in severe cases. Conclusion：The conclusion is satisfying the qality of seeing the doctor about thePatients ,we need to complete The total accounting way in advance,and strengthen the management of health care,and reduce the economic burden of the hospital.