上海跨省异地联网结算实施情况分析  

Analysis on the implementation of across province networking settlement in Shanghai

作　　者：滕晓梅 廖祖达 朱丽莉[1] 邵建华[1] 陈澍[1] 刘杨[1] 刘华晔[1] 程沛然[1] TENG Xiao-mei;LIAO Zu-da;ZHU Li-li;SHAO Jian-hua;CHEN Shu;LIU Yang;LIU Hua-ye;CHENG Pei-ran(Affiliated Huashan Hospital of Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院,上海200040

出　　处：《卫生软科学》2018年第12期57-61,共5页Soft Science of Health

摘　　要：介绍了上海作为参保地、就医地,跨省异地就医结算系统查询交易情况以及结算成功率。上海参保人员在外地跨省就医实时结算的省份中,江苏省结算人次最高、占84. 6%,医保基金支付比例最高的是广西、占92. 9%;跨省就医患者结算人次最多的为浙江省、占32. 9%,其次为安徽省、江苏省,分别占15. 7%、12. 4%;医保基金支付比例最高的为四川省、占75. 7%,所有省份的整体报销比例为59. 9%。在跨省结算中报错为主要原因,备案错误占35%。需通过优化社保卡制作流程、完善配套政策、加强宣传力度等措施以提高与各省市的对接率。It introduces inquiring transaction and settlement success rate of across province medical settlement system that shanghai is as the insured and seek medical advice place. In the provinces of across province medical settlement which Shanghai insured patients seek medical advice,the settlement person-time of Jiangsu province is the highest（84.6%）,the highest payment ratio of medical healthcare insurance fund is in Guangxi（92.9%）,the settlement person-time of across province settlement is in Zhenjiang（32.9%）,next are Anhui（15.7%）,and Jiansu（12.4）,the highest payment ratio of medical healthcare insurance fund is in Sichuan（75.7%）,the overall reimbursement ratio in all provinces is 59.9%. Wrong reimbursement is main cause of across province medical settlement,mistake records is 35%. To improve the butt joint with other provinces by the measures of optimizing manufacturing flow of social security cards,perfecting supporting policies,strengthening publicity force.

关 键 词：异地就医 医疗费用 结算系统 

分 类 号：R197[医药卫生—卫生事业管理]