新时代医院医保管理创新性理论与精细化管理实践研究

Research on Innovative Theory and Fine Management Practice of Hospital Medical Insurance Management in New Era

该研究提出实行院内医保精细化管理,通过信息系统进行监控;建立医保查房机制,宣传医保政策规定;搭建医、保、患三方平台。通过3个医院医保管理举措共同构建出该院医保管理体系,优化费用结构,保障患者权益,降低患者就医负担,创造更优质的社会效能。从而得出医院医保办不仅仅是患者就医的保障和向导,还是"医院与医保经办机构加强联系沟通的纽带和桥梁",更是医患之间关系的维护者,在医保政策不断变换的当下,及时适应相关政策,灵活机动,有针对性采取相应措施保障三方利益。

The study suggests to implement the hospital’s medical insurance fine management and monitor through the information system, establish the mechanism of medical insurance rounds and publicize the policies and vegulations of medical insurance, acticely build a platform for communioantim among hospitals, social security cenfers and patuebts. The three hospital medical insurance management measures, we jointly constructed our hospital medical insurance management system,optimized the fee structure, protected the rights and interests of patients, reduced the burden of medical treatment for patients, and created better social efficiency. Then, the hospital’s medical insurance office is not only a guarantee and guide for patients to seek medical treatment, but also "a link and bridge between the hospital and the medical insurance agency to strengthen communication", it is also a maintainer of the relationship between doctors and patients. At the moment when the medical insurance policies are constantly changing, we should adapt to relevant policies in a timely manner, be flexible and take targeted measures to protect the interests of the three parties.