医保投诉与医院管理因素影响的评价及分析

Assessment and analysis on hospital management influencing medical insurance complain

结合当前医院管理实际情况,从患者及其家属对医疗保险有理解偏差、医院对医保管理重视度不足、医院出现不合理收费或者操作失误等方面分析了医保投诉的原因,并提出强化医保政策的宣传力度、提高医务人员医保服务意识、实现多元化的投诉管理渠道、做好门诊医保管理工作、保障住院各环节医保管理顺畅、规范医保收费制度等应对策略,以强化医院管理,降低医保投诉率。

Based on the status quo of hospital management, the causes of medical insurance complain were analyzed in aspects of misunderstanding of medical insurance by patients and their family, insufficient attention of medical insurance management, irrational medical expense and operation error. Recommendations on improving hospital management and decreasing medical insurance complain rate which can be described as strengthening medical insurance policy spreading, improving medical staff service awareness, extending complain channels, highlighting on outpatient medical insurance management, assuring hospitalization medical insurance process smooth and regularizing medical insurance price were presented.