医疗机构实现新农合异地即时结报研究.PDFVIP

特别专题 Exclusive Subject 网络大会获奖论文选登 医疗机构实现新农合异地即时结报研究 毛云鹏① 冯昌琪② 林晓东② 于志华② 邓韧② 沈明辉② 付鹏② 王帅② 郑子荣② 摘 要 新农合异地即时结报就是参合农民在新农合定点医疗机构住院治疗，出院时由定点医疗机构按规定初审并垫付应给 农民的新农合补偿费用，再由定点医疗机构与统筹地区新农合经办机构定期结算的过程。目前新农合参合人员外地生病就 诊住院后都是由病人全额支付住院费用，再回到户口所在地进行结算报账，一次异地就诊结算时间长，且手续烦多，既不 方便参合人员，也给新农合管理机构增加了大量的工作量，解决参合人员异地就诊实时结算已成为急需解决的问题。四川 省在实现新农合异地即时结报时，采用Web Service技术为定点医疗机构医院信息系统提供一套业务流程接口，使定点医疗 机构通过医院信息系统实现异地住院即时结报。通过该系统将使参加新农合的农村居民得到更好的医疗卫生服务，帮助他 们减轻医疗负担，减少患重大疾病的风险。 关键词 新农合 医疗机构 异地即时结报 Doi:10.3969/j.issn.1673-7571.2013.12.001 Research on New Rural Cooperative Offsite Real-time Compensation / MAO Yun-peng, FENG Chang-qi, LIN Xiao-dong, et al//China Digital Medicine.-2013 8(12): 06 to 09 Abstract Now the NVMS offsite compensation is facing a series of problems. First of all, For a long time, the complex procedures of compensation, that is not only inconvenient for patients, but also increase a lot of work to the management agencies. Secondly, the NCMS paid all medical expenses and then applied for reimbursement with a hospital receipt and other necessary documents of proof. Moreover, lead to the emerge of compensation interruption, delayed, decrease in the degree of farmer benefits. The new rural cooperative offsite real-time compensation is a concentrated expression of policies to support and benefit co-farmers. The relevant policies stipulated that the patients of co-farmers paid the pocket payment for inpatient service at designated medical institutions and then received reimbursements from the NCMS funds in accordance with the regulations. In order to realize the new rural cooperative offsite real-time compensation, Sichuan province used the Web Service technology to Provides a set of interfaces for hospital information system to deal