摘要
目的:摸清基层医院医疗服务能力与医保基金管理现状,分析基层医保监管的问题及难点。方法:成立课题组,通过发放调查问卷、召开座谈会和实地访谈等形式开展调研分析。结果:获得148家县区一级医院28000多条数据。结论:基层医院医保监管工作存在监管力量弱、有效监控难、违规界定难、违规频次高、监管手段落后等问题。建议:通过完善医保定点医疗机构的准入机制、促进医院自我管理、实施医保智能化监管和建立医保信用管理制度等措施解决基层医院医保基金监管难题。
Objective:To fi nd out the current situation of medical service ability and medical insurance fund management of grass-roots hospitals,and analyze the problems and diffi culties of grass-roots medical insurance supervision.Methods:A research group was established to carry out investigation and analysis in the form of questionnaire,symposium and fi eld interview.Results:More than 28000 data from 148 county-level hospitals were obtained.Conclusion:There are some problems in the medical insurance supervision of grass-roots hospitals,such as weak supervision force,diffi cult eff ective monitoring,diffi cult defi nition of violations,high frequency of violations,backward supervision means and so on.Suggestion:Solve the problem of medical insurance fund supervision in grass-roots hospitals by improving the access mechanism of designated medical institutions of medical insurance,promoting hospital self-management,implementing intelligent supervision of medical insurance and establishing medical insurance credit management system.
作者
邹华章
Zou Huazhang(Suqian Medical Insurance Research Association,Suqian,223800)
出处
《中国医疗保险》
2021年第12期62-66,共5页
China Health Insurance
关键词
基金监管
调查问卷
对策研究
宿迁市
fund supervision
questionnaire
countermeasure research
Suqian City
