我国跨省异地医保联网直接结算的问题与策略研究

Study on the Problem and Strategy of Real-time Settlement of Cross-Provincial Medical Insurance in China

跨省异地医保联网直接结算已经从网络搭建阶段转入便民惠民阶段,政策的实施将为患者、医保经办机构、医疗机构和整个社会四方面带来利益和潜在风险。从信息系统、医保政策、结算范围、报销待遇、备案管理和费用监管等方面分析存在问题,针对性的提出完善跨省异地医保联网直接结算的策略建议。

The real-time settlement of inter-provincial health insurance had been transferred from the stage of network construction to the phase of convenience for people. The implementation of the policy would bring benefits and potential risks to patients,medical insurance agencies,medical institutions and the community. It analyzed the existing problems from the aspects of information system,medical insurance policy,settlement scope,reimbursement treatment,record management and expense supervision. Targeted recommendations were made to improve the real-time settlement of inter-provincial health insurance.