我国基本医疗保险异地就医管理探讨  

Discussions on basic medical insurance management for those seeing doctors out of hometown in China

作　　者：陈秋晓[1] 孙亦晖[2] 姚志刚[2] 张莹[2] 姜忠[2] 

机构地区：[1]苏州大学,江苏省苏州市215000 [2]苏州大学附属第二医院

出　　处：《中华医院管理杂志》2013年第2期81-83,共3页Chinese Journal of Hospital Administration

摘　　要：基本医疗保险在我国尚未形成统筹共识，缺乏统一的异地就医规范，出现了参保人员异地就医复杂困难、异地就医个人负担重、异地“冒名就医”导致骗取医疗保险基金等违规现象及社会保障部门缺乏信息共享以致监管难等问题。本研究在介绍了我国基本医疗保险异地就医的现状并分析异地就医管理中存在的问题后，提出基本医疗保险异地就医管理应着力于管理制度统一化、医疗保险信息网络化、就医结算联网化，并按照卫生体制改革的总体要求，分阶段地逐步推进。A consensus remains unsettled yet for basic medical insurance and common protocols on managing patients seeing doctors out of their hometown. This results in such setbacks as difficulty in seeing doctors elsewhere for those covered and in unaffordable financial burden, as well as medical insurance fraud, lack of information sharing among social insurance authorities, and difficulty of supervision. This study described the status quo of seeding doctors elsewhere under China＇s basic medical insurance system, and analyzed problems found in the management framework. On such basis, authors proposed such recommendations as unified management system for seeding doctors elsewhere, network information sharing for medical insurance information,and networked settlement for medical expenses for basic medical insurance. These measures should be cdrried out as per general requirements for health reform stage by stage.

关 键 词：基本医疗保险 异地就医 管理 

分 类 号：F842.6[经济管理—保险]