医院医保拒付管理的实践做法之研究

Study on the Practice of Hospital Medical Insurance Nonpayment

随着现在社会经济的快速发展,各个领域也得到了相应的发展。医疗保险制度也进行了相应的改革,随着医保政策的实施,各个医院的医保费用超额压力逐渐显露出来,因此,在医院领域医院医保拒付是经常遇到的问题。由于医保政策的全面普及,参加医保的人员越来越多,但是大部分对应的医院医保预付总额上涨不明显,使得医保拒付的额度逐渐增加,出现此问题的原因,主要是由于缺乏良好的医保拒付管理。文章讲述医保和医保拒付定义,提出了医院医保拒付管理在患方、保方和院方存在的问题以及研究了医院医保拒付管理的实践做法,最后对其进行了综合讨论。

With the rapid development of social economy,various fields have been developed correspondingly.Medical insurance system has been reformed accordingly.With the implementation of medical insurance policy,the pressure of medical insurance cost excess in hospitals has gradually emerged.Therefore,refusal to pay medical insurance in hospitals is a common problem.Due to the comprehensive popularization of medical insurance policy,more and more people are participating in medical insurance. However,the total amount of medical insurance prepayment in most hospitals does not rise significantly,which makes the amount of medical insurance refusal gradually increase.The main reason for this problem is the lack of good management of medical insurance refusal.This paper describes the definition of medical insurance and medical insurance refusal,puts forward the problems existing in patients,insurers and hospitals of medical insurance refusal management,and studies the practice of medical insurance refusal management in hospitals,and finally discusses them comprehensively.