公立医院改革形势下北京市某医院医保管理工作实践探讨  

Exploration of the Health Insurance Management under Public Hospital Reform in a Hospital,Beijing

作　　者：魏俊丽[1] 赵冠宏[1] 严松彪[1] 孙树学[1] 孙晶晶[1] 

机构地区：[1]首都医科大学附属北京友谊医院,北京100050

出　　处：《医学与社会》2013年第5期33-35,共3页Medicine and Society

摘　　要：北京市践行公立医院改革,该院作为北京市唯一一家首个全面试点单位,同时试行两个分开,三个机制。在公立医院改革形势下,为医保管理工作带来了机遇和挑战。该院采取了调整费用结构,形成有效谈判机制,追溯落实机制,合理激励的措施加以管理,取得了初步成效,服务量增加,次/例均费用、个人自付有所下降。改革初步试行,管理精细化要求与信息系统滞后之间、管理目标与个人利益之间、短期试点效果与长期预期之间、新管理措施与旧制度之间在实践过程中存在着矛盾,需要随着试点的推广予以探讨解决。The hospital in Beijing is the first hospital practicing the ＂Three openings and three mechanisms＂ at the same time in Beijing public hospitals reform. Medical insurance management in hospital is facing the opportunity and Challenge under the new situation. The hospital strengthen the management in the following aspects：adjusted the cost structure, formed effective negotiation mechanism and retrospective mecha- nism, conducted reasonable economic incentive. To take measures, volume of services increased, the average cost and individual pays decreased. With the promotion of reform, the following contradictions will be solved ： the management requirements against the lag of information systems, the management objectives against personal interests, the short- term the pilot effect against long- term expected, new management measures against the old system.

关 键 词：医疗保险 公立医院 

分 类 号：R197.3[医药卫生—卫生事业管理]