医院医疗保险管理的实践与思考

医保经办机构的管理目标是用最低廉的医疗费用保障参保人员的基本医疗,并确保医保基金收支平衡。医院从医保角度出发,通过病案质量管理,开展合理医疗,控制不合理费用,取得最大收益。在探究影响医保管理实效的同时,医保定点医院费用结付问题、医疗质量与费用控制问题、患者冒名就医和转院问题值得关注和思考。

The consideration and practice of the medical insurance management of hospital

The aim of medical insurance agencies is to maintain basic activities with the lowest cost to people involved,and ensure the balance of medical insurance fund.The hospital can gain the maximum benefit by improving quality of medical record and medical service,optimizing medical management and minimizing unreasonable expense.While exploring the factors affecting the medical insurance management,we should also consider the problems such as medical insurance fund payment,medical service quality and medical charges control,and patient who is identity theft and hospital transference.