我国各省城镇职工基本医疗保险门诊特殊疾病政策比较研究  

Comparatively Studying on the Policies of Outpatient Special Diseases of Urban Employee's Basic Medical Insurances

作　　者：段承阿鑫 常峰[1] 路云[1] 

机构地区：[1]中国药科大学国际医药商学院,江苏南京211198

出　　处：《中国卫生事业管理》2017年第5期342-345,369,共5页Chinese Health Service Management

基　　金：国家自然科学基金面上项目"基于社会网络理论的老年慢性病健康管理最优模式研究"(编号:71673298)

摘　　要：门诊特殊疾病政策是城镇职工基本医疗保险制度的一项重要内容,对保障职工基本医疗权益、减轻患者个人负担以及控制统筹基金的支出风险具有重要意义。文章通过综合比较全国主要省市的门诊特殊疾病政策,对病种管理、认定管理、就医管理和结算管理进行重点研究,对门诊特殊疾病政策施行中存在的问题进行分析,为完善门诊特殊疾病管理提供建议。As an important content of the urban employee＇ s basic medical insurance, policy of outpatient special diseases is significant to protect the employee＇ s basic medical rights, reduce theindividual burden and control the expenditure risk of the financing fund. The policies of outpatient special diseases of urban employee＇ s basic medical insurances in several provinces were comparatively studied from disease management, identification management, medical servicesmanagement and settlement management. Furthermore, the existing problems were analyzed to put forward suggestions for improving the outpatient special disease management.

关 键 词：门诊特殊疾病 病种管理 认定管理 就医管理 结算管理 

分 类 号：F842.684[经济管理—保险] R197.1[医药卫生—卫生事业管理]