异地医保实时结算现状分析和对策:以上海某三级医院为例

The Status Analysis and Countermeasures of Real-Time Settlement about Off-Site Medical Insurance: Taking A Tertiary Hospital in Shanghai as An Example

为了更好地解决跨区域流动人口的就医问题,上海市从2017年8月起开始推进全国异地医保实时结算工作.以上海某家三级医院为例,通过Excel分析该院异地结算患者情况,采取访问法了解异地医保实时结算的现状及问题,并针对这些问题提出可行性解决方案.研究分析发现,该院10917例异地医保患者中,67.57%来自于长三角地区,人数处于不断上升中,政策解释难度加大,治疗需求高,报销比例有差异,网络平台不稳定.建议加强区域合作,统一标准,建立稳定的信息传输平台,不断探索优化备案就医流程.

In order to better solve the problem of medical treatment for migrants across the region, Shanghai began to promote the real-time settlement about off-site medical insurance in China from August 2017. Taking a tertiary hospital in Shanghai as an example, the situation of patients in the hospitalwas analyzed by Excel, and survey method was adopted to investigate the status quo and problems of real-time settlement of remote medical insurance, and concrete and feasible solutions were proposed to these problems. According to the research and analysis, 67.57% of the 10917 patients in the hospital were from the Yangtze River Delta. The number of people was rising, the difficulty of policy explanation increased, the treatment demand was high, the reimbursement rate was different, and the network platform was unstable.It was suggested to strengthen regional cooperation, unify standards, establish a stable information transmission platform, and constantly explore and optimize the filing and medical treatment process.