整体性治理视域下异地就医结算管理路径优化研究  

Study on Path Optimization of Off-site Medical Settlement Management from the Perspective of Holistic Governance

作　　者：吴亭瑶 柏雪 WU Tingyao;BAI Xue(Suzhou University,Suzhou Jiangsu 213000,China)

机构地区：[1]苏州大学,江苏苏州213000 [2]常熟理工学院,江苏常熟215500

出　　处：《卫生经济研究》2024年第8期61-64,共4页

基　　金：国家社科基金青年项目“健康中国战略下全民基本医疗保险制度实施路径研究”(19CSH065)。

摘　　要：我国异地就医结算存在医保政策、监管及经办服务的“碎片化”问题,整体性治理理论和国际实践经验可以为完善我国异地就医结算管理提供优化路径:切实推进分级诊疗政策;以政府为中心,创新监管机制;实现医保结算政策标准化,统筹推进全民医保建设;建立和完善异地就医领域法律法规;推行“综合柜员制”,规范异地就医经办流程;稳步推进信息化建设。In off-site medical settlement in China,there was the problem of"fragmentation"of medical insurance policies,supervision and handling services.The theory of holistic governance and international practical experience can provide an optimal path to improve the management of off-site medical settlement in China.It is necessary to effectively promote the policy of hierarchical diagnosis and treatment,innovate the supervision mechanism centered on the government,realize the standardization of medical settlement policy to promote the construction of universal medical insurance,establish and improve the laws and regulations in the field of off-site medical treatment,implement the"integrated teller system"to standardize the process of off-site medical treatment,and steadily promote the construction of information technology.

关 键 词：异地就医 整体性治理 统筹层次 监管体系 经办服务 

分 类 号：F840.684[经济管理—保险]