医疗机构规范使用医保基金的探讨

The Research of Standardized Use of Medical Insurance in Medical Institutions

随着新医改的深入推进,基本医疗保险也得到蓬勃发展,正逐步迈向实现全民医保的奋斗目标。但是医疗机构不规范的医疗行为无形之中造成了医保基金的流失和浪费,成为目前我国基本医疗保险改革的重点难题。本文根据医疗机构使用医保基金的现状,分析医保基金在医疗机构使用方面存在的风险,将管理的触角延伸到医疗机构医保业务的每个薄弱环节,约束医疗机构的医疗行为,控制医疗费用不合理增长,达到科学合理使用医保基金的目的。

With the deepening of the new medical reform, the development of basic medical insurance have been booming. Our country is gradually moving towards the goal of universal health insurance coverage. But the non-standard medical behaviors in medical institutions cause the loss and waste of medical insurance fund, which becomes the crux of basic medical insurance reform. According to the current usage of medical insurance fund, this study analyzed the risks of using medical insurance and the weak links in the management of health care business, tried to constrain the medical behaviors in medical institutions, to control unreasonable growth of medical expense and achieve the goal of scientific and rational use of medical insurance fund.