分析新医改背景下医保支付所存问题及解决策略  

Analysis of the problems and solutions of medical insurance payment under the new medical reform

作　　者：马月丽[1] 赵燕华[1] 谢汪传 Ma Yueli;Zhao Yanhua;Xie Wangchuan(Medical Insurance Office,the Third People's Hospital of Zhaoqing City,Guangdong Zhaoqing 526060)

机构地区：[1]肇庆市第三人民医院医保办,广东肇庆526060

出　　处：《中国社区医师》2021年第5期178-179,共2页Chinese Community Doctors

基　　金：基金课题名称新形势下创新医保管理模式对医院发展的作用研究,基金课题编号:201904031520

摘　　要：目的:探析新医改背景下精神病患者医保支付所存问题,且于前者基础上提出解决方针。方法:选取2018年2月-2019年1月精神科患者80例及医保财务工作人员11人,进行相关调查研究,探析医保支付方式现存的相关问题及相应患者满意度,总结解决对策。结果:财务人员提出现阶段支付标准合理性不足占45.45%,对医疗水平的激励作用不足占27.27%,医疗服务体系不协调占27.27%。按服务项目付费,患者满意度最高(88.75%),按人头付费最低(7.50%)。结论:医院仍存在付费标准不合理及服务体系协作效率低等问题,当前应侧重于目前医保支付方式的制定机制改革上,完善服务体系的协同问题,才可进一步提升医院基本医疗服务质量。Objective:To explore the problem of medical insurance payment for mental patients under the new medical reform,so as to put forward the solution policy on the basis of the former.Methods:From February 2018 to January 2019,80 cases of psychiatric patients and 11 medical insurance financial staff were selected to investigate and study the existing problems of medical insurance payment and the corresponding patients'satisfaction and summarize the countermeasures.Results:The financial staff proposed that 45.45%of the lack of reasonableness of the payment standard at the emergence stage,27.27%of the lack of incentives for the medical level and 27.27%of the medical service system uncoordinated.Paid for services has the highest patients'satisfaction(88.75%)and the lowest payment was per capita(7.50%).Conclusion:The hospital still has the problems of unreasonable payment standard and low efficiency of service system cooperation.At present,we should focus on the reform of the mechanism of medical insurance payment and improve the coordination of service system,in order to further improve the quality of hospital basic medical services.

关 键 词：新医改背景 医疗保险 支付方式 现存问题 解决方法 

分 类 号：R197.1[医药卫生—卫生事业管理]