慢病有序管理实现路径.pdfVIP

管理平台 慢病有序管理的实现路径 周猇莉 （湖北省宜都市医疗保险管理局 宜都 443300） 【摘要 】建立专业化的评审队伍、规范化的评审流程、病情资料评审与现场体检评审相结合的评审方式， 是准确界定慢病的重要前提 ；实行治疗定点、费用定额、支付定项、用药定量的 “四定”管理，对参保人 员享受门诊慢病待遇的资格实行年年申报、年年评审制度，形成 “能进能出、进出有序”的管理运行机制， 是制度可持续的要求。 【关键词 】门诊慢病 ；界定程序 ；“四定”管理 ；进出有序 【中图分类号】 【文献标识码】 【文章编号】 F840.684 C913.7 A 1674-3830(2014)4-43-3 doi:10.369/j .issn.1674-3830.2014.4.11 The Approach in A chieving Sequential Management of Chronic Diseases Xiaoli Zhou (Medical Insurance Bureau of Yidu, Yidu, 443300) 【 】The establishment of a professional assessment team, a standardized procedure of assessment, Abstract and the combinative assessment of illness condition and checkup condition, is the prerequisite to accurately defi ne chronic diseases. The implementation of “ four determination”, such as treating in appointed institutions, expenditure limitation, payment specifi cation, drug use quantifi cation; the qualifi cation of the insured to enjoy chronic disease treated at outpatient department to be applied and evaluated annually, therefore to form a mechanism of “ allowing entering or exiting, entering or exiting in order”, are the requirement of sustainability of the system. 【 】outpatient chronic diseases, the procedure of assessment, the management of “four Key words determination”, entering and exiting in order 慢病具有用药周期长、治疗费 1规范界定程序，实行阳光操作 1.1评审队伍专业化。2007年成 用高的特点，对普通家庭是一种沉 慢病种