信息化管理在医保跨省异地就医住院费用直接结算中的应用

Application on information management in direct settlement of cross-province hospitalization under basic medical insurance scheme

基本医疗保险跨省异地就医住院医疗费用直接结算工作在首都医科大学附属北京友谊医院自推行至今已半年有余,目前整体运行平稳。异地参保人员住院费用直接结算在缩短报销周期,减轻患者就医经济压力,保障医保基金安全方面的作用逐渐显现。首都医科大学附属北京友谊医院充分利用信息化管理探索此项工作,从成立信息系统故障应急小组、优化信息功能、建立统计分析体系、搭载远程诊疗平台4方面逐一展开工作,并对信息化管理在现阶段遇到的问题和未来在直接结算工作中的发展提出了建议。

It has been over half year since the smooth implementation of direct settlement in cross-province hospitalization under basic medical insurance scheme in Beijing Friendship Hospital affiliated to Capital Medical University.The direct settlement of hospitalization expenses cross provinces can effectively reduce the reimbursement time,reduce disease economic burden and assure insurance fund safety.Beijing Friendship Hospital affiliated to Capital Medical University has made full use of the information management from four perspectives which can be described as establishing emergency response teams,optimizing information system,constructing statistical analysis system and setting up the remote diagnosis and consultation work platform.In addition,suggestions on the problems of information management and its development in future direct clearing have been presented.