关于医保拒付问题的分析及对策探讨  

Analysis and countermeasures discussion on the problems of medical insurer refused to pay

作　　者：陈炜炜[1] 丁天鹏[2] 施根林[2] 温美林 

机构地区：[1]山西医科大学公共卫生学院,山西太原030001 [2]武警江苏省总队医院,江苏扬州225003

出　　处：《卫生软科学》2015年第7期436-438,共3页Soft Science of Health

摘　　要：随着医保政策的全面普及和广泛覆盖,参保的服务人群逐渐增加,医保患者越来越多的占据了住院和门诊份额。然而对应的医院医保预付总额上涨不明显,医保类型报销差异大、更新速度快,医、保、患三方未形成良性互动,加上医保协议自身的缺陷等导致医院医保拒付严重。医保政策给医院带来了机遇和挑战,笔者从医、保、患三方面分析了引起医保拒付的原因并提出对策,以助于降低医院医保拒付额,促进医院运营形成稳健良性发展。With the comprehensive popularization and wide coverage of medical insurance policy, the crowd of medicare patients gradually increased, more and more to occupy the inpatient and outpatient. However, health-care prepaid amount is not obviously rising to the corresponding hospitals, types of insurance reimbursement have big differences, update quickly, hospitals, insurance, patients, with three parties did not form the benign interaction, plus insurance agreement it＇s own defects and such on, hospital medical insurance is hard to pay. Health insurance policy brings opportunities and challenges to the hospitals, to reasonably analyze the problems which are existing in the current health insurance management, overall discussion, help to reduce the amount of hospital medical insurer refused to pay, form benign and stable development of hospital operation.

关 键 词：医保管理 医保拒付 拒付原因 

分 类 号：F840.684[经济管理—保险]