异地就医患者对直接结算政策实施的效果评价——以北京X医院为例  

Evaluation on the effect of direct settlement from the views of patients receiving medical treatment in other places——Take X hospital in Beijing as an example

作　　者：杜会征 焦卫平[1] DU Hui-zheng;JIAO Wei-ping(Xuanwu Hospital of Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院,北京100053

出　　处：《卫生软科学》2022年第4期79-82,91,共5页Soft Science of Health

摘　　要：[目的]调查分析北京X医院出院结算的异地参保人对政策实施的了解程度及满意度情况,发现异地就医管理服务工作中存在的问题并提出针对性建议。[方法]对2021年3-7月到该院医保办公室咨询及办理业务的异地参保人进行自填式问卷调查。本次调查共回收有效问卷200份,采用描述性统计方法进行分析。[结果]调查显示,77.5%的参保人对政策实施的了解情况较少,仅有30.0%的参保人清楚此次异地就医的报销规定。约有61.0%的参保人通过线下途径办理备案手续,住院的平均排队等待时间为2~4周。异地参保人对直接结算政策实施的总体满意度较高[(4.24±0.55)分],但在备案手续办理流程[(3.69±0.72)分]、报销比例[(3.53±0.67)分]及住院排队等待时间[(3.43±0.68)分]的满意度相对较低。[结论]政策的实施提升了参保人就医获得感,减轻了参保人就医的经济负担。但存在参保人政策知晓率较低、住院排队时间长、属地化管理导致“待遇差”等问题。建议加快推进分级诊疗制度与转诊转院制度相结合,通过建立双向转诊制度开展集中预约床位的机制方式,缩短异地参保人住院排队等待时间。采取“点对点”政策宣传培训方式进一步提高参保人对异地就医结算政策的知晓率。Objective To investigate and analyze the understanding and satisfaction of non local insured in discharge settlement x hospital of Beijing on the implementation of the policy,find out the problems existing in the management and service of non local medical treatment,and put forward targeted suggestions.Methods A self-administered questionnaire survey was conducted among non local insured who went to the medical insurance office of the hospital for consultation and business from March to July 2021.A total of 200 valid questionnaires were collected and analyzed by descriptive statistics.Results The survey showed that 77.5% of the insured knew little about the implementation of the policy,and only 30.0% of the insured knew the reimbursement regulations for non local medical treatment.About 61.0% of the insured went through the filing procedures through offline channels,and the average waiting time in the queue for hospitalization was 2-4 weeks.The overall satisfaction of non local participants with the implementation of the direct settlement policy was high(4.24 ± 0.55),but their satisfaction with the filing procedures(3.69 ± 0.72),the reimbursement proportion(3.53 ± 0.67) and the waiting time in hospital queue(3.43 ± 0.68)were relatively low.Conclusions The implementation of the policy improves the insured’s sense of medical access and reduces the insured’s economic burden.However,there are some problems,such as low awareness rate of the insured’s policy,long hospital queuing time,and“poor treatment” caused by localized management.It is suggested to accelerate the combination of hierarchical diagnosis and treatment system and referral system,and carry out the mechanism of centralized reservation of beds through the establishment of two-way referral system,so as to shorten the waiting time of inpatients with remote medical insurance.Adopt the “point-to-point” policy publicity and training to further improve the insured’s awareness of the settlement policy for medical treatment in other places.

关 键 词：异地就医 医疗保险 直接结算 满意度 

分 类 号：R197[医药卫生—卫生事业管理]