非理性就医对医保费用管理的挑战及应对策略

目的分析参保患者非理性就医现象,积极探索应对策略,为控制不合理增长的医疗费用提供参考。方法结合我院医保工作中对医保基金正确合理使用的管理及参保患者的就医情况,分析近年来参保患者非理性就医的现象、原因及结果,探索应对策略,总结规范化管理的措施。结果小病大治、大病贵治、无病保养等是非理性就医的主要表现,严重影响医保费用的管理,助推了过度医疗和医疗费用的不合理增长。结论应落实国家医药卫生体制改革,完善配套的医疗保险政策,深化医院医保费用管理,科学控制基本医疗付费总额,控制医疗费用不合理增长,从而保障医保基金的安全使用。

Irrational Medical Challenge to Health Care Quality Management and Coping Strategies

Objective To analyze the phenomenon of irrational medical insurance patients,and actively explore the coping strategies,to provide reference for controlling the unreasonable increase of medical cost.Methods Combined with medical management and medical insurance patients in our hospital to the medical insurance fund is correct and reasonable use of the analysis in recent years,non reason and result of rational medical phenomenon,the insured patients,explore coping strategies,summarize the measures of standardized management.Results The minor illness treatment as a serious disease,with more money to treat the serious disease,erenif not ill some one also go to the hospital to keep fit,that is the main performance of the non rational medical treatment,seriously affecting the quality of management in health care costs,boosting the unreasonable growth of excessive medical treatment and medical expenses.Conclusion The implementation of national medical system reform,improve supporting medical insurance policy,deepen the hospital medical insurance cost management,scientific control of basic medical payment amount,controlling the irrational increase of medical expenses,to guarantee the safety of the use of insurance funds.