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我国城镇基本医疗保险制度实旋十余年,对医院医保管理始终是经办机构的重头戏。一方面,参保人员的医保待遇必须通过医院提供医疗服务才能实现;另一方面,医保政策又必须通过医院才能贯彻落实。同时,医院还是实现医保基金合理支出的关键环节。尤其是近年来,医保管理的重点逐步从制度建设和扩幅向精确管理和费用控制转移,医院管理的重要性更加凸现。
China’s urban basic medical insurance system is more than ten years old, and the hospital medical insurance management has always been the highlight of handling agencies. On the one hand, the medical insurance for insured persons must be provided through the hospital to provide medical services; on the other hand, the medical insurance policy must be passed through the hospital in order to be implemented. At the same time, the hospital is still a key link in the rational expenditure of medical insurance fund. Especially in recent years, the focus of medical insurance management gradually shift from the system construction and expansion to the precise management and cost control transfer, the importance of hospital management more prominent.