中国医疗保险
中國醫療保險
중국의료보험
CHINA HEALTH INSURANCE
2014年
8期
9-12
,共4页
定点管理%医疗保险%经办管理
定點管理%醫療保險%經辦管理
정점관리%의료보험%경판관리
the Administration of Designated Institutions%Medical Insurance%Social Insurance Agency
根据十八届三中全会健全全民医保体系和进一步深化医改的新形势和新要求，各级社保经办机构要树立系统观念、理清管理思路、创新工作方法，从实施总额控制、推进付费方式改革、开展医疗服务监控、加强医保反欺诈、完善协议管理、推广医保医师管理等重点工作入手，不断完善医疗保险定点管理。其中主要把握以下方面：明确定位、坚守底线；推进依法行政、提高依法经办能力；顺应形势发展、加强前瞻性研究。
根據十八屆三中全會健全全民醫保體繫和進一步深化醫改的新形勢和新要求，各級社保經辦機構要樹立繫統觀唸、理清管理思路、創新工作方法，從實施總額控製、推進付費方式改革、開展醫療服務鑑控、加彊醫保反欺詐、完善協議管理、推廣醫保醫師管理等重點工作入手，不斷完善醫療保險定點管理。其中主要把握以下方麵：明確定位、堅守底線；推進依法行政、提高依法經辦能力；順應形勢髮展、加彊前瞻性研究。
근거십팔계삼중전회건전전민의보체계화진일보심화의개적신형세화신요구，각급사보경판궤구요수립계통관념、리청관리사로、창신공작방법，종실시총액공제、추진부비방식개혁、개전의료복무감공、가강의보반기사、완선협의관리、추엄의보의사관리등중점공작입수，불단완선의료보험정점관리。기중주요파악이하방면：명학정위、견수저선；추진의법행정、제고의법경판능력；순응형세발전、가강전첨성연구。
According to the guidelines of the Third Plenary Session of its eighteenth Central Committee to improve the universal medical insurance and to deepen Health Reform, the social Insurance agencies at all levels should establish a systematical concept, straighten out management ideas and innovate work methods. The management of designated institutions should be improved constantly at the following important aspects: controlling medical insurance budget, promoting imbursement methods reform, monitoring medical services, intensifying anti-insurance-fraud, improving agreement administration and extending the management of medical insurance physicians and so on. The following signifi cant points need be emphasized: positioning accurately, sticking to the bottom line, improving the ability of law enforcement, adapting to the situation and promoting prospective studies.
