高莉

[摘要] 自2011年以来，北京市在市属医院推行医保总额预付的医保管理政策，作为定点医疗机构，医院的医保收入占医疗收入的比重逐年增加，因此做好医院医保财务管理工作，保证医院平稳运行，已成为医院刻不容缓的工作。尤其是当医院需要逐步从综合向专科医院转型过程中，如何切合医保总额预付指标，以不变应万变，对医院的医保财务管理工作提出了更高的要求。本文主要从医保总额预付的内涵入手，提出转型期医院的医保财务管理工作的影响和挑战，思考在医保总额预付制下，医院应从加强医保总额预付的预算、预算与成本相结合、优化HIS系统数据，使其切合医保财务管理需求的要求及构建以医保种类的明细科目的财务核算等财务管理应对策略。

[关键词] 医保总额预付；医院转型；财务管理

[中图分类号] R19 [文献标识码] A [文章编号] 1673-7210（2017）09（c）-0185-04

[Abstract] Beijing has carried out total medical insurance prepaid policy in city hospitals since 2011. Hospitals′medical insurance income proportion increased year by year as appointed medical institutions. Therefore， it has become an urgent task for hospitals to ensure the smooth operation of hospital medical insurance financial management， especially when the hospital needs to gradually transform from integrated to specialized hospital. Higher requirements are put forward for the management， in order to fit for quota insurance and cope with shifting events. This article mainly from the definition of the total medical insurance prepaid to put forward the influence and challenge of hospital medical insurance financial management during the transformation period. The hospital should meet the requirements and construct financial management coping strategies such as the financial accounting of medical insurance types by strengthening the total amount of the medicare budget， keeping budget in balance with cost and optimizing HIS system data

[Key words] Total medical insurance prepaid； Hospital transformation； Financial management

随着基本医疗保险的全面覆盖，医院的医保收入占收入的比重逐年增加，已成为医院财务资金补偿的重要组成部分，这一定程度提升了医院对医保资金的整体关注。随着中国老龄化进程的加剧，北京小汤山医院（以下简称“我院”）为了更好地适应发展需要，需要逐步由三级综合医院向三级专科康复医院转型，医院转型，意味着医疗收入的结构、费用支出的构成、救治人群的范围等方面出现差异，然而医保总额预付在一定时期是不会改变的，为保障医院平稳运行，医保总额预付款……