跨省就医直接结算在北京某医院的运行分析

Operation Analysis of Direct Settlement across Provinces in Beijing

某医院是北京市异地就医试点医院,自2017年2月接到试点通知后,迅速成立工作小组、制定工作方案、优化服务流程与服务内容,全面落实跨省异地就医住院费用直接结算工作,运行平稳,取得良好阶段性效果。服务人次不断增加;结算等待天数由初始的1.5天降至0.61天;主要服务的人群是退休人员和50岁以上老年人;前来就诊的患者遍布28个省份和新疆生产建设兵团,但主要来自北京市周边医疗资源相对匮乏的省份;就诊科室集中在眼科和耳鼻喉科。通过总结分析,建议系统监控结算情况,关注人力资源配比,探索适合异地就医的付费方式,强化分级诊疗体系建设,引导有序合理就医。

After receiving the pilot notice in February, 2017, a working group in a hospital in Beijing was set up, the work programme was formulated, the service flow and service content were optimized, and the direct settlement of hospitalization expenses across provinces was implemented in an all-round way. At present, the operation is stable and achieved good results. The number of people receiving services increased continuously, and the number of waiting days decreased gradually from 1.5 days to 0.61 days.The main service groups are retirees and elderly people over the age of 50.The patients came from 28 provinces and Xinjiang Production and Construction Corps, but mainly from the provinces around Beijing with relatively scarce medical resources.The visiting departments are concentrated in ophthalmology and department of ENT. Through summary and analysis, it is suggested that the system should monitor the settlement situation, pay attention to the allocation of human resources, explore appropriate payment methods, and guide orderly and reasonable medical treatment.