CAJ | 학술논문

基本医疗保险在我国尚未形成统筹共识,缺乏统一的异地就医规范,出现了参保人员异地就医复杂困难、异地就医个人负担重、异地“冒名就医”导致骗取医疗保险基金等违规现象及社会保障部门缺乏信息共享以致监管难等问题.本研究在介绍了我国基本医疗保险异地就医的现状并分析异地就医管理中存在的问题后,提出基本医疗保险异地就医管理应着力于管理制度统一化、医疗保险信息网络化、就医结算联网化,并按照卫生体制改革的总体要求,分阶段地逐步推进.
기본의료보험재아국상미형성통주공식,결핍통일적이지취의규범,출현료삼보인원이지취의복잡곤난、이지취의개인부담중、이지“모명취의”도치편취의료보험기금등위규현상급사회보장부문결핍신식공향이치감관난등문제.본연구재개소료아국기본의료보험이지취의적현상병분석이지취의관리중존재적문제후,제출기본의료보험이지취의관리응착력우관리제도통일화、의료보험신식망락화、취의결산련망화,병안조위생체제개혁적총체요구,분계단지축보추진.
A consensus remains unsettled yet for basic medical insurance and common protocols on managing patients seeing doctors out of their hometown.This results in such setbacks as difficulty in seeing doctors elsewhere for those covered and in unaffordable financial burden,as well as medical insurance fraud,lack of information sharing among social insurance authorities,and difficulty of supervision.This study described the status quo of seeding doctors elsewhere under China's basic medical insurance system,and analyzed problems found in the management framework.On such basis,authors proposed such recommendations as unified management system for seeding doctors elsewhere,network information sharing for medical insurance information,and networked settlement for medical expenses for basic medical insurance.These measures should be carried out as per general requirements for health reform stage by stage.