京津冀一体化下异地医保直接结算和联动机制的构建

The Construction of Direct Settlement and Linkage Mechanism of Medical Insurance under the Jing-jin-ji Integration

在京津冀一体化背景下,由人员流动而引发的异地就医问题突出,受京津冀三地医疗保险制度差异、医疗资源不均衡等因素的影响,异地就医结算难。针对上述问题,本文通过探讨河北省内以及跨省医保结算模式,构建京津冀全范围内的异地医疗直接结算机制,同时针对异地医保直接结算可能带来的问题,构建医保联动机制,为京津冀异地医保的直接结算提供保障。

In the context of the Jing-jin-ji integration, the problem of remote medical insurance caused by the flow of personnel is prominent. It is affected by the differences between the medical insurance system of Beijing, Tianjin and Hebei Province and the imbalance of medical resources. In view of the above problems, this paper discusses the settlement model in Hebei province and across the province to build a full range of the Jing-jin-j1 region long-distance medical direct settlement mechanism. At the same time for the possible problems of the remote health insurance direct settlement, we will build a linkage mechanism for health care to ensure the direct settlement of medical insurance in the Jing-jin-ji region.