跨省异地就医门诊结算现状及优化建议——以江西省某三级医院为例  

Current Situation and Optimization Suggestions of Outpatient Settlement for Cross-Provincial Medical Treatment——Taking a Tertiary Hospital in Jiangxi Province as an Example

作　　者：裘双玉 张蓉[1] 蔡海清 

机构地区：[1]南昌大学第一附属医院,南昌330000 [2]江西省医疗保障局,南昌330025

出　　处：《中国医疗保险》2023年第9期100-105,共6页China Health Insurance

摘　　要：目的:以某三级医院为例,研究跨省异地就医患者门诊结算现状,并提出优化建议。方法:采用问卷调查法及访谈法收集数据,并进行定性、定量分析;选取正式切换上线国家医疗保障信息平台后(2021年12月至2022年12月)的跨省门诊结算数据,对分析结果进行二次验证。结果:多数患者对跨省异地就医费用报销政策有一定程度的了解,特别体现在异地长期居住人员和异地安置退休人员中,但仍有部分患者对政策不够了解。结论:建议优化跨省异地结算政策,完善信息支撑系统,加强定点医疗机构与统筹区协作等。Objective:Taking a tertiary hospital in Jiangxi Province as an example,the paper studies the current situation of outpatient settlement for patients seeking medical treatment across provinces to propose optimization suggestions.Method:We use questionnaire survey and interview methods to collect data and conduct qualitative and quantitative analysis.Also,we select the cross-provincial outpatient settlement data after the official switch to the national healthcare security information platform from December 2021 to December 2022,and perform a second validation on the analysis results.Result:Most patients understand the reimbursement policy for medical expenses across provinces to some extent,especially among long-term residents and retirees resettled in different regions.However,there are still some patients who do not have sufficient understanding of the policy.Conclusion:It is recommended optimizing the policy of cross-provincial settlement,improving the information system,and strengthening the cooperation between designated medical institutions and overall planning areas.

关 键 词：异地就医 门诊 基本医疗保险 直接结算 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]