医院医保服务规范在医保管理中的实践与思考——基于《全国医院医疗保险服务规范》实施情况问卷调查  

Practice and Consideration of Hospital Medical Insurance Service Standardization in Medical Insurance Management——Based on the Questionnaire Survey on the Implementation of National Hospital Medical Insurance Service Standards

作　　者：骆慧云 杨帆[2] 蒲春阳 唐丽萍 韩全意[5] Luo Huiyun;Yang Fan;Pu Chunyang;TangLiping;Han Quanyi(Department of Medical Insurance, Nanshan People's Hospital, Shenzhen, 518067;Departmentof Medical Insurance, Xinjiang Production and Construction Corps Hospital,Urumchi,830000;ConstructionOffi ce,Zhuhai Integrated Traditional Chinese and Western Medicine Hospital,Zhuhai,519000;College of ContinuingEducation, China Medical University,Shenyang,110001;Medical Insurance Committee of China HospitalAssociation,Beijing,100088)

机构地区：[1]广东省深圳市南山区人民医院医保科,深圳518067 [2]新疆生产建设兵团医院医保办,乌鲁木齐830000 [3]广东省珠海市中西医结合医院创建办,珠海519000 [4]中国医科大学继续教育学院,沈阳110001 [5]中国医院协会医保专委会,北京100088

出　　处：《中国医疗保险》2019年第5期54-58,共5页China Health Insurance

摘　　要：目的:促进医疗保险与医疗服务和谐、健康、可持续发展,指导各级各类医疗机构的医疗保险内涵建设,提升服务水平。方法:通过检查、评估《全国医院医疗保险服务规范》的落地情况,进一步规范医院的医疗保险管理服务工作,完善医院医疗保险工作制度和管理机制,实现医院医疗保险管理的制度化、规范化、程序化。结果:医保从业人员综合素质和医保胜任能力明显提高,但也存在一些问题与不足,有待持续改进。结论:规范化、制度化是医保管理提质增效不可或缺的有效手段,加强医院医保规范化体系建设尤其重要。Objective: To promote the harmonious, healthy and sustainable development of medical insurance and medical services, to guide the connotation construction of medical insurance in various medical institutions at all levels, and to improve the service level. Methods: By examining and evaluating the landing situation of National Hospital Medical Insurance Service Standard, we further standardized the hospital medical insurance management and service work, improved the hospital medical insurance work system and management mechanism, and realized the institutionalization, standardization and procedural management of hospital medical insurance. Results: The comprehensive quality of medical insurance practitioners has improved signifi cantly, but there are still some problems and shortcomings, which need to be improved continuously. Conclusions: Standardization and institutionalization are indispensable and effective means to improve the quality and efficiency of medical insurance management, and it is particularly important to strengthen the construction of hospital medical insurance standardization system.

关 键 词：医院医保服务规范 调查问卷 执行情况 问题与治理建议 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]