中国医疗保险
中國醫療保險
중국의료보험
CHINA HEALTH INSURANCE
2013年
9期
56-58
,共3页
医疗保险服务协议%医疗费用%拒付%思考
醫療保險服務協議%醫療費用%拒付%思攷
의료보험복무협의%의료비용%거부%사고
agreement of medical insurance services%medical expenses%dihonor%thinking
定点医院在与医保经办机构结算医疗费用时，部分费用被拒付的现象时有发生。尽管原因诸多，但从医院方面看，预防拒付的根本之道在于加强管理，严格履行医疗保险医疗服务协议，准确贯彻执行医保政策和管理规定，完善内部监督检查和考核奖惩机制，建设医院与医保互联互通的信息系统等；医保与医院要建立平等原则下的协商谈判机制，签订互利共赢的医疗服务协议。
定點醫院在與醫保經辦機構結算醫療費用時，部分費用被拒付的現象時有髮生。儘管原因諸多，但從醫院方麵看，預防拒付的根本之道在于加彊管理，嚴格履行醫療保險醫療服務協議，準確貫徹執行醫保政策和管理規定，完善內部鑑督檢查和攷覈獎懲機製，建設醫院與醫保互聯互通的信息繫統等；醫保與醫院要建立平等原則下的協商談判機製，籤訂互利共贏的醫療服務協議。
정점의원재여의보경판궤구결산의료비용시，부분비용피거부적현상시유발생。진관원인제다，단종의원방면간，예방거부적근본지도재우가강관리，엄격리행의료보험의료복무협의，준학관철집행의보정책화관리규정，완선내부감독검사화고핵장징궤제，건설의원여의보호련호통적신식계통등；의보여의원요건립평등원칙하적협상담판궤제，첨정호리공영적의료복무협의。
The cases that partial expenses were repudiated constantly happen when the designated hospitals settle the medical expense with health insurance agencies. Despite the complex factors for this problem, it is essential for the hospital to prevent the repudiation by strengthening the management, carrying out the health insurance service protocol strictly, impelling the health insurance policy and management discipline precisely, perfecting the internal self-regulation and rewards&punishment mechanism, establishing the information system between hospital and health insurance agency. The hospitals should create a negotiation mechanism with the health insurance agencies under the principle of equality, and sign a medical service protocol that has mutual benefit.
