从门急诊医保拒付个案探讨加强医保患者门急诊管理  

Investigation on the Improvement of Medical Insurance Patients Management from a Protest Case in Outpatient and Emergency Department

作　　者：郭娜[1] 张晨[1] 

机构地区：[1]首都医科大学宣武医院,北京市100053

出　　处：《中国病案》2014年第9期15-16,5,共3页Chinese Medical Record

摘　　要：随着医疗保险政策的逐步深入与推广,医保拒付已成为困扰医疗保险管理机构、医院及医务人员的难题。在医保付费改革总额预付方式下,以医保拒付个案从供方(医院)、患方(参保人员)具体分析其产生的原因,并提出医院实现精细化管理、建立门诊电子病案信息资源库、加强门诊病案信息的规范化管理、完善信息系统、加强对参保人员的管理等方法,降低医院拒付金额,缓和医患之间的矛盾,构建和谐的就医环境。With the development and promotion of medical insuiance policy gradually, medical insurance protest has become a problem that troubled many medical insurance management institutions, hospitals and medical staff. Under the reform of total amount advanced payment mode of medical insurance payment, we made a concrete analysis on the reason of its generation through a protest case from both hospitals and patients, and put forward measures such as to realize delicacy management, establish electronic information resource database of medical records, strengthen the standardization management of medical records information, complete information system and enhance the management of the insured persons, thus to decrease the protest amount of the hospital, alleviate the contradiction between doctors and patients and build a harmonious medical environment.

关 键 词：医疗保险 拒付管理 病案 

分 类 号：R197.323[医药卫生—卫生事业管理]