全域化视角下医疗保险门诊费用异地结算政策完善思考  

Thoughts on the Improvement of Remote Settlement Policy on Medical Insurance Outpatient Fee from the Perspective of Globalization

作　　者：郑先平[1,2] 吴超男 童潇 刘雅[1] ZHENG Xian-ping;WU Chao-nan;TONG Xiao(Economic and Management School,Jiangxi University of Traditional Chinese Medicine,Nanchang,330004,China;Nankai Research Center for Health Economics and Medical Insurance,Tianjin,300350,China)

机构地区：[1]江西中医药大学经济与管理学院,南昌330004 [2]南开大学卫生经济与医疗保障研究中心,天津300350

出　　处：《中国卫生经济》2021年第10期35-38,共4页Chinese Health Economics

基　　金：江西省社会科学规划一般项目(16GL33);江西中医药大学经济与管理学院2021年度研究生科研训练计划项目。

摘　　要：完善医疗保险异地就医直接结算政策,是新时期我国提高医保公共管理服务效能的重要工作内容之一。目前,我国已在全国范围内基本实现跨省异地就医住院费用直接结算,显著提升参保人的获得感、幸福感和满意度。而异地就医门诊费用直接结算,因其结算服务频次更高、影响人数规模更大、涉及范围更广以及操作更为复杂,实现难度更大。文章在整理分析试点地区相关政策的基础上,概括总结异地就医门诊费用直接结算的基本特征及现阶段存在的问题,建议从提高统筹层次、增加定点医疗机构数量、加强医保基金监管及信息化建设等方面入手,建立健全异地就医门诊费用直接结算运行平台,以期为完善医疗保障体制、机制建设提供决策参考。Improving the direct settlement policy for medical insurance in different places is one of the important tasks for improving the efficiency of medical insurance public management services in China in the new era.At present,China has basically realized the direct settlement of hospitalization expenses across provinces and other places across the country,which has significantly improved the sense of gain,happiness and satisfaction of the insured.However,the direct settlement of outpatient expenses for medical treatment in different places is more difficult to achieve because of the higher frequency of settlement services,larger scale of affected people,wider scope and more complicated operations.Based on the analysis of relevant policies in the pilot area,it summarizes the basic characteristics of direct settlement of outpatient expenses for medical treatment in different places and the existing problems at this stage.It is recommended to promote the overall planning level,increase the number of designated medical institutions,strengthen the supervision of medical insurance funds and information construction,etc.Starting from the aspect,establish and improve the direct settlement operation platform for outpatient medical expenses in different places,in order to provide decision-making references for the improvement of the medical security system and mechanism construction.

关 键 词：医疗保险 门诊费用 异地就医 即时结算 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] F840.613[经济管理—保险]