从医保服务医师制度看临床医师角色转变

Discussion on role changes from clinical physician to medical insurance management based physician

全民医保时代给医保监控体系提出了更为严格的监管要求。医保服务医师制度的建立将医保监管对象从医疗机构延伸至医务人员,是健全综合监管体系、加强医保监管的重要手段。临床医师需要从思想观念、行政管理部门、服务规范、诊疗行为审核依据、沟通对象及内容、信息平台的使用、加强处方权限管理等方面实现医保医师角色的转变,才能更好地做好医保医师服务。此外医院医保管理应做好相应配套措施,医保经办部门应不断完善医保服务医师制度,健全医保监管体系。

The era of universal coverage requires strict supervision for the medical insurance monitoring system. The medical insurance management physician system extends medical insurance supervision from medical institutions to medical staff. It is an important means to improve the comprehensive supervision system and strengthen the supervision of medical insurance. In order to provide better health care, physicians need to realize the change of health care physician role from different aspects, such as the ideas, the administrative department, the service specifications, the audit basis of the diagnosis and treatment, the communicate objects and content, the use of information software, the administration of prescription rights. Furthermore, the corresponding measures should be taken in the hospital medical insurance management, and the medical insurance agency should continuously improve the medical insurance management based physician system and improve medical insurance regulation system.