基于医保基金治理的医疗收费监管规则标准化研究

Research on Standardization of Medical Charge Regulations Based on Medical Insurance Fund Management

目的建立适合医保基金治理新形势的标准化医疗收费监管规则。方法本研究运用了文献研究、召开座谈会、现场调查、比较分析的方法。结果案例省份价格项目不适应医疗新技术发展和群众就医需求;医保支付审核规定和价格收费政策没有联动统一;医嘱名称没有统一标准化,和收费项目不匹配。结论统一完善省份价格项目顶层制度设计,加强医院价格内部控制管理。

Objective:To establish the standardized regulatory rules of medical charges suitable for the new situation of medical insurance fund management.Method:The authors of the paper conducted literature research,held symposium,made field investigation,and performed comparative analysis.Result:They found that the price project of case province does not adapt to the development of new medical technology and the masses’demand for medical treatment;There is no linkage and unification between audit regulations for medical insurance payment,and price and charging policies;The name of medical advice is not standardized and does not match the charging items.Conclusion:Therefore,the top-level system design of provincial price projects will be unified and improved,and the internal control and management of hospital prices be strengthened.