城镇职工基本医疗保险异地就医管理服务模式探析-analysis on management and service mode of basic medical insurance for urban workers in different places.docxVIP

城镇职工基本医疗保险异地就医管理服务模式探析 城镇职工基本医疗保险异地就医管理服务模式探析 4 4 suggested measures are provided. At the same time, the article provides a set of networked solution methods to reimbursement problems for hospitaliztion in other places in provincial levels， and establish the short-term and long-term goals for hospitalization in other places. The short-term goal is focused on establishing the networked coorporation relation among different areas based on province-leveled management. And the long-term goal is to raise coorporation levels and upgrade the coorporation to a nation-wide level, improving the regional coorporation system and encouraging the networking examination system. To refine the plan, the principle of fair treatment, coorporation for mutural benefits, efficient manipulation and convienient service must be carried on. The Ministry of Human Resources and Social Security(MHRSS) must focus on unified lay-out and issue guiding suggestions to gradually establish regional management for hospitalization based on the principle of mutural trust. And MHRSS also should enforce the long-term system on hospitalization registration, networking reimbursement and regional examination. Keywords: medical insurance, hospitalization in other places, networking reimbursement, mangement service, solution analysis PAGE PAGE 1 0 前言 近年来，随着经济社会的快速发展，全国范围内人口流动规模和频率的加 大，人民群众医疗服务需求的提高与医疗资源配置不均衡的矛盾日益突出，异 地就医问题受到了社会各界的普遍关注。参保人员反映垫付多、报销周期长以 及报销手续复杂，人大、政协的建议和提案中也多次涉及这一问题。新出台的 深化医药卫生体制改革的《意见》和《实施方案》中分别明确指出“以异地安 置的退休人员为重点改进异地就医结算服务”、“建立异地就医结算机制，探索 异地安置的退休人员就地就医、就地结算办法”。 本文同时以两个统筹地区为异地假想案例，提出一套省级异地就医联网报 销问题解决模式，建立异地就医的近期和远期目标。近期目标是立足于现有条 件，通过省级部门组织指导、统筹地区协同参与，建立统筹地区之间的异地联 网就医的协作关系；远期目标是根据我国社会医疗保险的发展情况，提高统筹 层次，逐步实现省级统筹，把联网就医上升到国家层次，完善省级统筹地区间 的协作机制，最终形成全国性的异地就医联网和协查制度。 解决异地就医问题，对于完善我国医疗保障体系有着重要的意义。首先， 异地就医结算体现了‘以人为本’。”解决了不同统筹地区之间异地就医结算 的瓶颈，切实解决了老百姓异地就医困难。其次，异地就医结算为顺利实现“医 改”的目标奠定基础。中共中央和国务院下发了《关于深化医药卫生体制改革 的意见