某三甲医院跨省异地患者医保结算情况及问题分析  

Analysis on the Situation and Problems of Medical Insurance Settlement for Patients in Grade A Tertiary Hospital Across Provinces and Regions

作　　者：王珊珊[1] 林振吕[1] 涂磊昊 王晓玲 WANG Shanshan;LIN Zhenlyu;TU Leihao;WANG Xiaoling(Medical Insurance Office,the First Affiliated Hospital of Fujian Medical University,Fuzhou Fujian 350000,China)

机构地区：[1]福建医科大学附属第一医院医保办,福建福州350000

出　　处：《中国卫生标准管理》2023年第11期79-83,共5页China Health Standard Management

摘　　要：目的随着我国各统筹区跨省异地就医联网结算工作的不断推深推进,跨省异地就医更便捷高效,分析某三甲医院跨省异地就诊患者住院情况、医保结算情况以及跨省异地就医患者所遇到的问题。方法采用回顾性调查方法,分析某三甲医院2017年1月—2021年12月跨省异地就医患者数据以及医保结算数据。结果跨省异地就医患者以中老年患者居多;平均住院日逐年递减,跨省异地就医联网结算率在逐年提高,但结算过程中仍会遇到各种问题。结论跨省异地就医工作的开展给百姓带来便利,为医保工作创造了机遇,同时患者就诊过程所遇的问题也展示了诸多挑战与压力,仍需集合多方力量,进一步简化跨省就医流程,打通信息交互障碍,让信息跑腿,患者少走路,提高跨省异地医保结算率,提升就医体验感。Objective With the continuous promotion of the networking and settlement of medical treatment across provinces and regions in China,it is more convenient and efficient to seek medical treatment across provinces and regions.This article analyzes the hospitalization situation,medical insurance settlement situation,and problems encountered by patients seeking medical treatment across provinces and regions in grade A tertiary hospital.Methods A retrospective survey was used to analyze the data of patients and medical insurance settlement in grade A tertiary hospital from January 2017 to December 2021.Results The majority of patients seeking medical treatment across provinces and regions were middle-aged and elderly patients.The average hospitalization days are decreasing year by year,and the settlement rate of cross provincial and remote medical networking is increasing year by year.However,various problems still exist during the settlement process.Conclusion The implementation of trans-provincial and longdistance medical treatment work has brought convenience to the people and created opportunities for medical insurance work.At the same time,the problems encountered by patients during the medical treatment process have also demonstrated many challenges and pressures.It is still necessary to gather multiple forces to further simplify the trans-provincial medical treatment process,overcome obstacles to information interaction,allow information to run errands and patients to walk less,improve the settlement rate of trans-provincial and long-distance medical insurance,and enhance the sense of medical treatment experience.

关 键 词：跨省异地 医保结算 异地患者 三甲医院 结算现状 实际问题 

分 类 号：R197[医药卫生—卫生事业管理]