医院必须重视医疗保险部门的监督  

The necessity of hospitals attaching importance to the supervision by medical insurance departments

作　　者：崔泓[1] 张路 张大发[3] 

机构地区：[1]北京市医疗保险事务管理中心,100054 [2]北京市医院管理研究所 [3]北京市劳动和社会保障局医疗保险处

出　　处：《中华医院管理杂志》2000年第11期667-669,共3页Chinese Journal of Hospital Administration

摘　　要：1999年以来 ,北京市医疗保险事务管理中心监督部对北京市 175 6例 3万元以上的大额病历进行了审核 ,检查总金额 1 35亿元 ,其中不符合报销规定的 1381 1万元。笔者分析了核查中发现的问题 ,提出了医疗保险因其自身的性质所决定 ,必然要对医院加大监督力度。医院必须重视医疗保险部门的监督 ,通过加强管理 ,规范医疗行为 ,建立内部审核制度 ,提高效益等手段 ,控制医疗费用的过快增长 ,达到医疗保险部门的认同 ,在竞争中求得生存与发展。Since 1999, the Supervision Department of Beijing Medical Insurance Affairs Management Center has examined 1 756 medical records, each of which entailed a sum larger than 30 000 yuan. The total amount of money examined was 135 million yuan, of which 13.811 million yuan was not up to the standard for reimbursement. The paper makes an analysis of the problems found in the examination and puts forward the view that greater supervision of hospitals is necessitated by the nature per se of medical insurance. Hospitals must attach importance to the supervision by medical insurance departments and adopt such measures as strengthening management, standardizing medical behavior, setting up an internal examination system and improving benefits so as to control the too speedy increase of medical expenses, attain ratification by medical insurance departments and seek survival and development amidst competition.

关 键 词：医疗保险 医院管理 监督 医疗费用 

分 类 号：R197.32[医药卫生—卫生事业管理]