CAJ | 학술논문

通过医院和参保人两个途径对相关人员进行医院医保管理工作的调研，指出三甲医院医保管理工作存在有事实依据取证和处罚难、实时有效的监督和控制难、规范化管理监管难、参保对象的期望值与实际差距较大等4个方面的难点，进而提出完善政策体系，优化宣传策略、建立医保“一站式”服务体系、联合其他定点医院共同协议管理、设立监督岗位，强化监管力度等建议。
통과의원화삼보인량개도경대상관인원진행의원의보관리공작적조연，지출삼갑의원의보관리공작존재유사실의거취증화처벌난、실시유효적감독화공제난、규범화관리감관난、삼보대상적기망치여실제차거교대등4개방면적난점，진이제출완선정책체계，우화선전책략、건립의보“일참식”복무체계、연합기타정점의원공동협의관리、설립감독강위，강화감관력도등건의。
Based on the investigation of medical insurance management in hospital, 4 problems can described as difficult to take the evidence and punish, difficult to real time monitoring and control, difficult to regulation and the significant gaps between patient's expectation and actual compensation. Suggestions such as perfecting policy system, strengthening propaganda, setting one step medical insurance service system, contract management, setting full time supervision post and strengthening regulation.