面对医保发展新形势不断完善定点管理.pdfVIP

观察思考 面对医保发展新形势 不断完善定点管理 唐霁松 （人力资源和社会保障部社会保险事业管理 中心 北京 100013 ） 【摘要 】根据十八届三 中全会健全全 民医保体 系和进一步深化 医改的新形势和新要求，各级社保经办机 构要树立 系统观念、理清管理思路、创新工作方法，从 实施总额控制、推进付 费方式改革、开展 医疗服务监控、 加 强 医保反欺诈、完善协议 管理、推广 医保 医师管理等重点工作入手 ，不断完善 医疗保险定点管理。其 中 主要把握 以下方面 ：明确定位、坚守底线 ；推进依 法行政、提 高依 法经办能力 ；顺应形势发展 、加 强前瞻 性研究。 【关键词 】定点管理 ；医疗保险 ；经办管理 【中图分类号 】F840.684 C913.7 【文献标识码 】 A 【文章编号 】1674-3830 （2014 ）8-9-4 doi:10.369/j .issn.1674-3830.2014.8.2 Facing the Development Situation of Medical Insurance to Improve the Management of Designated Institutions ConstantlyTang Jisong (The Agency of Social Insurance Administration, the Ministry of Human Resource and Social Security, Beijing, 100013) According to the guidelines of the Third Plenary Session of its eighteenth Central Committee 【Abstract 】 to improve the universal medical insurance and to deepen Health Reform, the social Insurance agencies at all levels should establish a systematical concept, straighten out management ideas and innovate work methods. The management of designated institutions should be improved constantly at the following important aspects: controlling medical insurance budget, promoting imbursement methods reform, monitoring medical services, intensifying anti-insurance-fraud, improving agreement administration and extending the management of medical insurance physicians and so on. The following signifi cant points need be emphasized: positioning accurately, sticking to the bottom line, improving the ability of law enforcement, adapting to the situat