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医保实际补偿比例是指医保经办机构实际报销的医疗费用与患者医疗总费用的比率。医保实际补偿比例是衡量患者医疗费用补偿高低的重要指标,也从另一方面反映医保制度制定的合理性。分析医保实际补偿比例可减轻患者医疗过程中的经济负担,同时也能提高医保基金的使用效率。影响医保实际补偿比例主要有政策、医院、医生、患者等多方面因素,笔者从事医保工作十多年,认为正确理解影响实际补偿比例的因素,合理规避这些因素带来的负面影响,对提高医保实际补偿比例具有一定的作用。
The actual compensation ratio of health insurance means the ratio of the medical expenses actually reimbursed by the health insurance agency to the total medical expenses of the patients. The actual proportion of compensation for medical insurance is a measure of the level of compensation for patients with an important indicator of medical expenses, but also on the other hand reflects the health care system to develop the rationality. Analysis of the actual proportion of compensation for medical insurance can reduce the financial burden of patients in the medical process, but also can improve the efficiency of the Medicare Fund. The actual proportion of compensation that affects health insurance mainly includes many factors such as policies, hospitals, doctors and patients. The author has been engaged in medical insurance for more than 10 years. He believes that the correct understanding of the factors that affect the actual proportion of compensation, a reasonable avoidance of the negative impact of these factors, The actual compensation ratio has a certain effect.