CAJ | 학술논문

目的探讨医院引进商业保险理赔医疗费用的效果。方法在住院收费处旁设商业保险医院理赔办公室，患者在医院就诊结算后，直接到商业保险理赔办公室办理理赔手续，方便病人。结果2011年3月-2012年12月，门诊赔付373人次，发生金额25万元，赔付金额为13万元。住院赔付2028人次，发生金额1468万元，赔付金额396万元。结论医院引进商业保险现场理赔医疗费用是患者、医院、商业保险公司多方的需求，医院形成“就诊-理赔”一站式服务能够方便患者就医和理赔。
목적탐토의원인진상업보험리배의료비용적효과。방법재주원수비처방설상업보험의원리배판공실，환자재의원취진결산후，직접도상업보험리배판공실판리리배수속，방편병인。결과2011년3월-2012년12월，문진배부373인차，발생금액25만원，배부금액위13만원。주원배부2028인차，발생금액1468만원，배부금액396만원。결론의원인진상업보험현장리배의료비용시환자、의원、상업보험공사다방적수구，의원형성“취진-리배”일참식복무능구방편환자취의화리배。
Objective To investigate the effect of introducing commercial insurance claims for medical expenses in hospital. Methods Set up a commercial insurance claims office next to the hospital charges. Patients can directly deal with claims in the commercial insurance claims office after settlement in hospital. Results From March, 2011 to December, 2012, there have been 373 outpatients and 2028 inpatients claims, whose amount of medical expenses is 250,000 Yuan and 14.68 million Yuan while the compensation amount is 130,000 Yuan and 3.96 million Yuan respectively. Conclusion The introduction of on-site commercial insurance claims for medical expenses by hospital meets the demand of patients, hospitals and commercial insurance company. The one-stop service pattern of"treatment and claims settlement"in hospital is convenient for patients and claims settlement.