發(fā)布時(shí)間：2018-05-29 07:32

  本文選題：基本醫(yī)療保險(xiǎn) + 異地就醫(yī)��； 參考：《山西大學(xué)》2017年碩士論文

【摘要】：由于我國基本醫(yī)療保險(xiǎn)屬地化管理、各地統(tǒng)籌層級不同、醫(yī)保政策不同、各地籌資保障水平不同,導(dǎo)致異地就醫(yī)即時(shí)結(jié)算問題日益突出。各地在探索基本醫(yī)療保險(xiǎn)異地就醫(yī)結(jié)算方面做了很大努力,制定了符合本地區(qū)發(fā)展水平的政策,但是國家層面的統(tǒng)一政策還有待出臺。對基本醫(yī)療保險(xiǎn)異地就醫(yī)結(jié)算進(jìn)行研究,可以提高參保人員就醫(yī)自主選擇性,特別是重癥患者越來越多地享受到優(yōu)質(zhì)的醫(yī)療資源與醫(yī)療服務(wù),提高參保人員的醫(yī)療保障水平,解決參保人員異地就醫(yī)后費(fèi)用墊付多、報(bào)銷程序繁瑣、經(jīng)濟(jì)負(fù)擔(dān)重的問題,也可提高醫(yī)保經(jīng)辦機(jī)構(gòu)的工作效率,是一項(xiàng)便民工程。目前,我國各省已經(jīng)完成省內(nèi)基本醫(yī)療保險(xiǎn)異地就醫(yī)即時(shí)結(jié)算工作,各省也積極開展省外醫(yī)保異地就醫(yī)結(jié)算模式的探索,海南、上海等地區(qū)為全國各省做出很好的示范作用。但是,各地醫(yī)保異地就醫(yī)結(jié)算面臨政策差異大銜接困難、大病醫(yī)保異地就醫(yī)直接結(jié)算政策缺位、經(jīng)辦與政策上銜接的問題較多、信息系統(tǒng)互不相容、信息資源不能共享、異地就醫(yī)結(jié)算經(jīng)辦不規(guī)范,監(jiān)管及核實(shí)查處困難、個(gè)人負(fù)擔(dān)重墊付壓力大等各方面問題。放眼國際典型國家和地區(qū)解決異地就醫(yī)結(jié)算的方式,歐盟、美國、日本等國家,尤其是歐盟在法律、公共信息平臺、跨境醫(yī)療管理機(jī)制、醫(yī)療政策建設(shè)等方面為我國的頂層設(shè)計(jì)提供了有益的啟示。從我國實(shí)際出發(fā),通過對國內(nèi)外異地就醫(yī)即時(shí)結(jié)算管理模式和經(jīng)驗(yàn)的借鑒,對優(yōu)化異地就醫(yī)政策提出新的政策性思考。政府、經(jīng)辦機(jī)構(gòu)、參保人三個(gè)層面通盤考慮先行規(guī)劃,從異地就醫(yī)服務(wù)管理體系、信息系統(tǒng)軟硬件建設(shè)、經(jīng)費(fèi)管理和運(yùn)營等各個(gè)環(huán)節(jié),為這項(xiàng)工作的開展做好必要準(zhǔn)備。
[Abstract]:Because of the localization management of the basic medical insurance in our country, the different levels of overall planning, the different medical insurance policy and the different level of financing guarantee, the problem of immediate settlement of medical treatment in different places is increasingly prominent. All localities have made great efforts in exploring the settlement of medical treatment in different places of basic medical insurance, and formulated policies in line with the level of development of the region, but the unified policy at the national level has yet to be issued. A study on the settlement of medical treatment in different places of the basic medical insurance can improve the independent selection of the insured, especially the more and more serious patients enjoy quality medical resources and medical services, and improve the medical security level of the insured. It is a convenient project to solve the problem that the insured can pay more expenses in different places, the reimbursement procedure is cumbersome, and the economic burden is heavy. It can also improve the working efficiency of medical insurance agencies. At present, the provinces of our country have already completed the work of settling accounts for medical treatment in different places of basic medical insurance in the province, and the provinces have also actively carried out the exploration of the settlement mode of medical insurance in different places outside the province. Hainan, Shanghai and other regions have made a good demonstration role for the provinces of the whole country. However, local medical insurance accounts in different places face great difficulties in policy convergence, the direct settlement policy of medical insurance in different places is absent, there are many problems in connection between operation and policy, information systems are incompatible, and information resources cannot be shared. The medical settlement in different places is not standardized, the supervision and verification is difficult, the personal burden is heavy and the pressure is great. Looking at the way in which international typical countries and regions resolve the settlement of medical treatment in different places, the European Union, the United States, Japan, and other countries, especially the European Union, in its laws, public information platforms, and cross-border medical management mechanisms, The medical policy construction and so on has provided the beneficial enlightenment for our country top-level design. Starting from the reality of our country, this paper puts forward new policy thinking on optimizing the policy of seeking medical treatment in different places by drawing lessons from the management mode and experience of instant settlement of medical treatment in different places at home and abroad. The government, the agency and the insured have all considered the plan in advance, making necessary preparations for the development of the work from the aspects of the management system of medical service in different places, the construction of software and hardware of information system, the management of funds and the operation of the system.
【學(xué)位授予單位】：山西大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R197.1;F842.684

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