新形势下医保拒付费用原因及对策分析

Analysis on the Reasons and Countermeasures of Medical Insurance Refusing to Pay in the New Situation

随着国家医疗保障制度和管理体制的整合与统一,全民医保制度的改革发展,医保已成为医疗服务的最大买家。为确保基金合理使用,监管显得尤为重要。多年来,医保拒付时有发生,如何减少医保拒付也成为医院医保管理的关注点。本文以此为背景,通过对兰州市第一人民医院2017年职工医保拒付费用进行分析,找出原因并提出对策,旨在减少医保拒付,形成患者权益得维护、医院得发展和基金绩效有提升的良好局面。

With the integration and unification of national medical security system and management system,and the reform and development of national medical insurance system,medical insurance has become the largest buyer of medical services.In order to ensure the rational use of funds,supervision is particularly important.Over the years,medical insurance refusing to pay has occurred often.How to reduce this phenomenon has become the focus of hospital medical insurance management.Based on this background,this paper analyzes the data of the first people’s Hospital of Lanzhou in 2017,and finds out the reasons and puts forward countermeasures,aiming to reduce the phenomenon of medical insurance refusing to pay,and form a good situation in which patients’rights and interests are protected,hospitals are developed and fund performance is improved.