我国跨省异地就医直接结算业务协同机制建设及成效初探

A Preliminary Study on the Construction and Effect of the Coordination Mechanism of Cross-provincial Treatment Direct Reimbursement Services

本文基于协同理论,从公共管理服务视角对我国跨省异地就医直接结算业务的协同机制、主要内容和初步成效进行了分析。研究发现异地就医直接结算业务自2016年全面开展以来,在国家层面形成了以信息共享、问题协同为内循环,以在线备案、费用协查为外循环的双层协同机制。随着跨省异地就医直接结算业务覆盖面逐步扩大,惠及人群不断增加,协同方式日益丰富,未来的业务协同机制还需纳入多元化协同主体、扩充协同体系,并利用信息技术完善业务协同的移动化与智能化,进一步丰富医保公共服务手段。

We analyzed the core mechanism,main contents and initial results of the cross-provincial treatment direct reimbursement coordination platform at the national level from the perspective of public service management based on the coordination theory.It is found that the coordination mechanism has gradually developed and improved since 2016,and a two-layer coordination mechanism has been constructed,which place the information sharing and problem coordination as the internal coordination components,and online application and expense scrutiny as the external coordination components.As coverage of the coordination mechanism has been gradually expanded,benefi ting more and more people,and the collaborative methods have been increasingly diversifi ed,we suggest that the governors should include more collaborative subjects and expand the collaborative system,and use information technology to improve the mobile and intelligent property of business collaboration.