面对医保发展新形势 不断完善定点管理

Facing the Development Situation of Medical Insurance to Improve the Management of Designated Institutions Constantly

根据十八届三中全会健全全民医保体系和进一步深化医改的新形势和新要求,各级社保经办机构要树立系统观念、理清管理思路、创新工作方法,从实施总额控制、推进付费方式改革、开展医疗服务监控、加强医保反欺诈、完善协议管理、推广医保医师管理等重点工作入手,不断完善医疗保险定点管理。其中主要把握以下方面:明确定位、坚守底线;推进依法行政、提高依法经办能力;顺应形势发展。

According to the guidelines of the Third Plenary Session of its eighteenth Central Committee to improve the universal medical insurance and to deepen Health Reform, the social Insurance agencies at all levels should establish a systematical concept, straighten out management ideas and innovate work methods. The management of designated institutions should be improved constantly at the following important aspects： controlling medical insurance budget, promoting imbursement methods reform, monitoring medical services, intensifying anti-insurance-fraud, improving agreement administration and extending the management of medical insurance physicians and so on. The following significant points need be emphasized： positioning accurately, sticking to the bottom line, improving the ability of law enforcement, adapting to the situation and promoting prospective studies.