关于医保资金管理中存在的问题研究

Research on Existing Problems in the Medical Insurance Fund Management

目的分析研究我市医保资金管理情况,对其中存在的问题进行总结,并提出应对策略。方法对该市各大医院在2016年1—12月期间医保资金管理中出现的问题进行调查研究,并提出应对策略。结果该次调查研究结果显示,目前该市所有医院在医保资金管理中均存在较多的问题,主要问题为社会医疗保险与医院的财务管理存在差异;医保账务处理混乱;医保部门与财务部门处理医保资金过程中缺乏沟通等3个方面。结论针对该市各大医院2016年期间医保资金管理中存在的问题,提出的应对策略主要为加强各大医院的内控管理情况,权衡医院的收支平衡与医保相关政策法规;定期对医院的账目进行核对,强化医院账目核对制度;设置合理的会计科目,对医院的医保资金回收情况及时掌控。

Objective To analyze and research the medical insurance fund management in our city and summarize the existing issues and put forwards the solutions. Methods The problems in the medical insurance management in various big hospitals in our city from January to December 2016 were selected and the countermeasures were put forwards. Results The results showed that there were many issues in the medical insurance management in our city, mainly including the difference between the social medical insurance and hospital financial management, confused medical insurance fund handling, lack of communication between the medical insurance department and financial department. Conclusion We put forwards the countermeasures to enhance the internal control management of various big hospitals according to the issues exiting in the medical insurance fund management in 2016, consider the balance of income and expenses of the hospitals and medical insurance related regulations, regularly check the hospital account, enhance the hospital account check system, set the rational accountant and master the hospital medical insurance fund recycle situation in time.