张海燕北京市中西医结合医院医保办，北京　100039

新形势下医院医保的精细化管理

张海燕
北京市中西医结合医院医保办，北京100039

随着新医改的不断深入，我国基本医疗保障制度已覆盖全民，医保工作质量直接影响到医院技术、服务水平、甚至关系到医院的生存和发展。如何在新形势下完善患者、医保机构、医院之间的关系，做好医院医保精细化管理已成为医院的重要工作。精细化管理是提高医院整体管理水平的重要举措，是医保管理体制改革的必然趋势。医院通过医疗保险管理规范化体系建设，通过医疗保险工作的精细化管理，提高医疗保险管理工作效率，提高患者的满意度，同时也能使医保基金合理使用，使医院管理水平迈上新的台阶，同时打造医院品牌，实现医院的跨越式发展。

医院医保；精细化管理；措施

［Abstract］With the constant deepening of new medical reform，the basic medical insurance system of our country has covered the whole people，and the medical insurance work quality directly influences the hospital technology and service level，and even concerns the existence and development of the hospital，and how to improve the relationship between patients，medical insurance institution and hospital in new situation and do a good job in fine management of the hospital has been the major work of the hospital.Fine management is the major measure of improving the whole management level of the hospital and the inexorable trend of medical insurance management system reform.The hospital improves the working efficacy of medical insurance management，improves the satisfactory degree of patients，rationally uses medical insurance fund，pushes the hospital management to a new level，creates a new hospital brand and achieves leap-fonvard development of the hospital by the construction of medical insurance management standardization system and fine management of medical insurance work.

［Key words］Hospital medical insurance；Fine management；Measure

随着新医改的不断深入，我国基本医疗保障制度已覆盖全民，医保的范围越来越大，参保的人数也越来越多，医院的医保患者占据了更多的医院份额，医保付费方式根据基金收支预算实行总额控制。总额预付的实施结束了按项目报销的粗放式管理时期，踏入精细管理阶段［1］，对医院的医保管理提出更高的要求［2］。在医疗保险体系中医、患、保三方中，医院是联结保方和需方的桥梁，要加强医保管理，只有“医、患、保”三方达成协商共管、良性互动的“双赢”监督管理运行机制，才能使医疗保险真正步入良性循环的轨道，促进基本医疗保险工作健康持续发展。……