基本医疗保险服务协议的调查分析  

Investigation and analysis on basic medical insurance contract

作　　者：程苏华[1] 李敬伟[1] 王文凤[1] 陈伟[2] 田献氢[3] 刘方 郑雪倩[5] 高树宽[5] 

机构地区：[1]北京大学第一医院,北京市西城区西什库大街8号100034 [2]北京积水潭医院医患办 [3]卫生部中日友好医院医保办,北京市朝阳区樱花园东街100029 [4]北京市医疗纠纷人民调解委员会 [5]中国医院协会医疗法制专业委员会

出　　处：《中国医院》2012年第1期3-6,共4页Chinese Hospitals

摘　　要：目的:了解基本医疗保险管理的结构、社会医疗保险经办机构与定点医疗机构对《基本医疗保险服务协议书》实施中的意见,分析和探讨基本医疗保险的管理方式,提出研究建议。方法:对社会医疗保险经办机构和定点医疗机构进行问卷调查,结果用epidata3.0录入,SPSS15.0进行分析。结果:定点医疗机构均有准入制度,进行分级分类管理。医疗机构认为《基本医疗保险服务协议书》没有谈判机制,希望引进第三方进行谈判。《基本医疗保险服务协议书》没有明确的对社会医疗保险经办机构的约束、处罚条款。结论:社会医疗保险经办机构需要明确自身定位,与定点医疗机构沟通,共同制定相关指标,更好地维护参保人员的利益。Objectives： To learn the structure of basic medical insurance management,the social medical insurance institutes and contracted medical institutes＇ opinion on implementing basic medical insurance contract,analyze the management mode of basic medical insurance and to present suggestions.Methods： Questionnaire was given to social medical insurance institutes and contracted medical institutes.Data were input by epidata3.0 and were analyzed by SPSS15.0.Results： All the contracted medical institutes were admitted by administrative regulations and were disparity managed by grade and category.In the opinion of contracted medical institutes,there was no negotiation mechanism and no specific constraint and penalty item to social medical insurance institute in basic medical insurance contract and they hope to introduce the third party negotiation mechanism.Conclusions： Social medical insurance institutes need to clear the position of themselves,communicate with contracted medical institutes and joint design relative indictors to better protect the insured＇s benefit.

关 键 词：医疗保险 服务协议 

分 类 号：R197.32[医药卫生—卫生事业管理]