新医改背景下医院医保资金管理中存在的问题及相关对策研究

Research on Existing Issues and Related Strategies of Hospital Medical Insurance Fund Management under the Background of New Medical Reform

目的分析调查新医改背景下该院在医保资金管理中存在的问题,并针对相应的问题探讨其应对策略。方法对该院2016年1—12月期间对参保患者医保管理中存在的主要问题进行调查研究,并根据相应的问题提出针对性策略。结果该次调查研究中结果显示该院医保资金管理中存在的主要问题为医保财务工作人员的综合业务能力较低、与医保监管部门沟通不佳、对医保政策理解不到位、医院信息系统建设不完备、对科室的监管不到位等五个方面。结论针对该院2016年在新医改背景下医保资金管理中出现的问题,提出相应的应对策略有助于该院医保资金的管理,以期为其他医院的医保管理提供一定的参考。

Objective To analyze and investigate the existing issues of hospital medical insurance fund management under the background of new medical reform and discuss the countermeasures according to the corresponding issues. Methods The main issues in the medical insurance management of patients from January 2016 to December 2016 were selected and the targeted issues were put forwards according to the corresponding issues. Results The research results showed that the main issues in the medical insurance fund management were the low general business ability of the staff, bad communica-tion with the department of medical insurance supervision, poor understanding of medical insurance policy, imperfect hospi-tal information system construction and insufficient supervision of the department. Conclusion Putting forwards the counter-measures contributes to the management of the medical insurance funds in our hospital according to the issues of medical insurance fund management under the background of new medical reform in 2016 in order to provide a certain reference for the hospital medical insurance management.