重庆市规范医疗保险经费管理相关问题研究

Research on Standardizing the Medical Insurance Cost Management Relevant Problems in Chongqing

医疗保险基金的科学管理和合理使用是整个医疗保险制度的核心,也是保障其健康持续运行的根本。随着经济社会快速发展、人口老龄化日益加剧、医疗技术日新月异,如何建立合理的医保基金使用与管理机制,使医保基金的使用与管理更加科学、规范、高效,达到既能降低医保基金风险,又为参保患者提供优质医疗服务、且能保障医院正常运行发展的目的,成为医保管理部门和定点医疗机构共同面临的难题。为全面分析重庆市医保基金总体情况和管理过程中存在的问题,促进医保基金有效、合理使用提供参考,该研究通过专项调研,找出了医保基金管理中筹资、分配、支付、监督中存在的问题,并对管理工作提出了相应工作建议。

The scientific management and rational use of medical insurance funds is the core of the whole medical insurance system,and it is also essential to ensuring the healthy and sustainable operation.With the rapid development of economy and society,growing ageing of population and ever-changing medical technology,how to establish the rational medical insurance fund use and management mechanism,make the use and management of medical insurance fund more scientific,standardized and effective,reduce the medical insurance fund risk,provide excellent medical services for the patients insured and ensure the normal operation and development of the hospital have been the common difficult problems faced by the medical insurance management department and designated medical institutions,thus providing reference for comprehensively analyzing the total situation of medical insurance fund in Chongqing and existing problems in the management course,and promoting the effective and rational use of medical insurance,and we find out the problems of medical insurance fund management in fund-raising,allocation,payment and supervision through the specific research and put forwards the corresponding work suggestions for the management work.