公立医院与商业保险合作模式的探索

Exploration of cooperation modes between public hospitals and commercial insurance

本文从建立医院自己的商业保险管理、服务团队,建立了较为全面的医院与商业保险合作流程规范,搭建商业保险实施技术平台,借助远程技术延伸医疗服务半径,多种渠道扩展合作空间这5个方面介绍了中日友好医院与商业健康保险的合作发展路径。分享了医院取得的经验和启示:提高了患者满意度,降低了医患纠纷风险;降低了医疗耗材价格。从专科专病保险、手术/麻醉意外保险、远程医疗保险、慢病管理保险这几个方面提出了未来公立医院与商业保险合作时可以考虑的方向。

This paper introduces the path of cooperation and development between China-Japan Friendship Hospital and commercial health insurance from five aspects:establishing the hospital’s own management and service team of commercial insurance,establishing the relatively comprehensive cooperation norms between the hospital and commercial insurance,building a technical platform for the implementation of commercial insurance,extending medical services with the help of remote technology,and expanding cooperation space through various channels.The experiences and enlightenment obtained by the hospital are shared;patients’satisfaction is improved;the risk of doctor-patient conflicts is reduced;the price of medical consumables is reduced.The cooperation between public hospitals and commercial insurance in the future can be considered from the aspects of specialized disease insurance,surgery/anesthesia accident insurance,telemedicine insurance,chronic disease management insurance.