推进医保结算制度改革 加强医保监督制约作用

Promote Reform of Medical Insurance Settlement System and Strengthen Restriction and Supervision System of Medical Insurance

以医保部门对定点医疗机构的医保费用结算为研究对象,以定点医疗机构对药品生产流通企业的药品货款结算为分析对象,探究医保费用结算和药品货款结算之间的关联性。结果发现:医保费用结算拨付的时间差容易形成医保部门、定点医疗机构和药品生产流通企业间的三角债问题;公立医院补偿不足,存在拖欠药品货款、结算周期较长问题。为此,福建省偿试改革药品货款结算机制,由医保部门以医疗机构应收医保费用结算款代为支付药品货款,建立医保统一结算药品货款制度。

The Medical Insurance Department＇s settlement of medical insurance expenses for designated medical institutions was selected as the research object, and the drug settlement of pharmaceutical production and circulation enterprises was analyzed by designated medical institutions. It found that the time difference between medical insurance fee settlement and payment was easy to form the triangle debt problem among the medical insurance department, the designated medical institution and the pharmaceutical production and circulation enterprises. Public hospitals had insufficient compensation, arrears drug debt and long settlement period. There fore, as for the compensable drug payment settlement mechanism reform, the medical insurance department should pay the costs of medical insurance by medical institutions, and establish a unified payment system for Medicare.