民营医保定点医疗机构管理现状及对策——以唐山市为例

The Present Management Situation and Countermeasure Research of Private Hospital in Medical Insurance Designated Medical Institution——Taking Tangshan City as an Example

截至2013年11月底,唐山市城镇基本医疗保险定点医疗机构共158家,其中民营定点医疗机构49家,所占比例高达31%,主要集中于一级及一级以下医院。通过对这些定点医疗机构进行现场核查并参考市医疗保险系统上传信息,可以看到,民营医院相对于公立医院,运营上仍存在一定的问题,个别医院为了摆脱经营困境、谋取高额经济利益,挂床住院、过度检查等现象依然存在。通过对这些问题进行分析,有针对性的提出建议对策,以更好地保证医保基金的有序、合理支出。

By the end of November,2013,The number of the designated medical institutions in basic medical insurance of Tangshan City is 158,including 49 private medical institutions,the proportion is as high as 31%,Mainly in first grade and the following one grade. Through site verification of the designated medical institutions and uploading the information in medical insurance system of the city,We understand that,private hospital compared with public hospitals,some problems still exist in operation,Some hospitals in order to get out of the predicament,seek profits,set false beds in hospital,do excessive examination. Based on the analysis of these problems,put forward suggestions of countermeasures,in order to ensure the orderly,reasonable expenses of the medical insurance fund.