京津冀异地就医直接结算政策执行偏差问题研究

Research on the implementation deviation of direct settlement policy for remote medical treatment in Jingjinji Metropolitan Region

加快实现异地就医直接结算服务是保障公民享受公平、可及、高效的基本医疗卫生服务,实现健康公平的必然要求。如何推动直接结算政策的有效执行成为行业内共同关注的热点问题。作者提出“执行堕距”的概念,从宏观与微观相连接的视角来解释异地就医政策为何执行难、为何容易在基层走样。研究结果显示,京津冀跨省直接结算政策执行情况未能达到预期效果,应从资源协同、医保标准协同、结算模式协同和内外监管协同的角度出发,引导和保障异地就医结算,缩小“执行堕距”,助力京津冀异地就医联网结算政策真正执行到位。

Accelerating the direct settlement of medical treatment in different places is a necessary requirement to ensure that citizens enjoy fair,accessible,and efficient basic medical and health services and to achieve health equity.How to promote the effective implementation of the direct settlement policy has become a hot issue of common concern.This paper proposes the concept of"implementation lag"to explain why the implementation of remote medical treatment policy is easy to misfit.The implementation of the policy has not achieved the expected results.The local government of Beijing,Tianjin,and Hebei should guarantee the direct settlement policy from the perspective of resource coordination,medical insurance standard coordination,settlement mode coordination,and supervision coordination to narrow the"implementation lag",and facilitate the implementation of the direct settlement policy.