长三角门诊费用跨省直接结算政策实施效果初探--以上海数据为例

Implementation Effect Study on Inter Provincial Direct Settlement Policy of Outpatient Expenses in Yangtze River Delta Urban Agglomeration--Taking Shanghai Data as an Example

《中共中央国务院关于深化医疗保障制度改革的意见》明确提出要“加快完善异地就医直接结算服务”。为贯彻落实长三角区域一体化国家战略,推进长三角民生领域一体化发展,2018年9月起,长三角沪苏浙皖三省一市在全国率先启动门诊费用跨省直接结算的区域试点。为充分评估长三角门诊结算政策实施效果,向国家进一步推广提供区域经验,笔者于近期开展了长三角门诊结算实施效果专项调研。结果显示,长三角门诊结算政策普惠性强,以异地就医需求内部结构调整为主,患者受益面广,就医状态有序可控。为解决调研中发现的结算系统不稳定、病种覆盖不全等问题,未来应在加强信息化建设、推进目录统一、加强宣传引导等方面再做努力,更大程度满足参保群众异地就医便利结算需求。

The Opinions of the CPC Central Committee and the State Council on Deepening the Reform of the Healthcare Security System clearly proposes to speed up the improvement of the direct settlement service for off-site medical treatment.In order to implement the national strategy of regional integration of Yangtze River Delta Urban Agglomeration and promote the integrated development of people's livelihood,Shanghai,Jiangsu,Zhejiang and Anhui have taken the lead in launching a regional pilot project of inter provincial direct settlement of outpatient expenses since September 2018.In order to fully evaluate the implementation eff ect of outpatient settlement policy in the Yangtze River Delta Urban Agglomeration and provide regional experience for the country,the author recently carried out a special investigation on the implementation eff ect of outpatient settlement policy in the Yangtze River Delta urban agglomeration.The results show that the outpatient settlement policy of the Yangtze River Delta urban agglomeration is highly inclusive,and mainly focuses on the internal structural adjustment of the demand for medical treatment in other places.The patients benefi t a wide range,and the medical treatment status is orderly and controllable.In order to solve the problems found in the survey,such as unstable settlement system and incomplete coverage of diseases,we should make further eff orts in strengthening information construction,promoting directory unifi cation,and strengthening publicity and guidance in the future,so as to meet the needs of the insured people for convenient settlement of medical treatment in diff erent places to a greater extent.