新形势下生育保险费用精细化管理探索与实践 ——基于某三级综合性医疗机构视角
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南京医科大学第一附属医院

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Exploration and Practice of Refined Management of Maternity Insurance Expenses in the New Situation——Based on the perspective of a three-level comprehensive medical institution
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The First Affiliated Hospital of Nanjing Medical University

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    摘要:

    城市公立医院医疗服务价格改革后,部分医疗服务收费价格提高,生育医疗费用上升,加之二孩政策全面实施,生育保险基金支出大幅增加,当期结余率下滑,基金运行压力剧增,医疗机构生育保险费用管理压力随之增大。在新形势下,将有限的生育保险基金做到最大化、最优化利用,实现生育保险费用的精细化管理,对医疗机构整体运行发展具有重要意义。文章基于某三级综合性医疗机构视角,简述在职工医保与生育保险合并的趋势下,医院医保管理部门对生育保险精细化管理的探索与实践,为医院医保管理部门提升生育保险费用精细化管理水平提出政策建议。

    Abstract:

    After the reform of medical service prices in urban public hospitals, the price of some medical services increased, the cost of maternity medical care increased, and the two-child policy was fully implemented. The pressure on expense management has increased.Under the new situation, maximizing and optimizing the use of limited maternity insurance funds and realizing the precise management of maternity insurance costs are of great significance to the overall operation and development of medical institutions. Based on the perspective of a three-level comprehensive medical institution, the article briefly describes the exploration and practice of the fine management of maternity insurance by the hospital medical insurance management department under the trend of the merger of employee medical insurance and maternity insurance, and improves the refinement of maternity insurance costs for the hospital medical insurance management department. Management level puts forward policy recommendations.

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历史
  • 收稿日期:2019-12-06
  • 最后修改日期:2020-07-15
  • 录用日期:2020-10-20
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