Research on the problems and countermeasures of direct settlement for chronic and special critical dis-eases in cross provincial outpatient service——taking suzhou S hospital as an example
10.3969/j.issn.1671-332X.2023.12.001
- VernacularTitle:跨省门诊慢特病直接结算存在问题与对策研究
- Author:
Zheng JI
1
;
Qian ZHOU
Author Information
1. 苏州大学附属第二医院 江苏苏州 215004
- Keywords:
Trans-provincial and remote medical treatment;
Outpatient treatment for chronic and special critical disea-ses;
Direct settlement;
Medical insurance management
- From:
Modern Hospital
2023;23(12):1805-1808,1813
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the current implementation status and existing problems of direct settlement for chronic and special critical diseases in cross provincial outpatient service policies,propose improvement strategies and suggestions,pro-vide reference for further improving direct settlement for chronic and special critical diseases in cross provincial outpatient service policies,enhance patient satisfaction and convenience in seeking medical treatment,and jointly maintain the safety of medical in-surance funds.Methods Extract settlement data from chronic and special critical diseases in cross provincial outpatient service and medical insurance service platform data from S Hospital,collect and sort out the difficulties encountered in daily settlement,and analyze the problems and reasons in the implementation of settlement policies.Results Direct settlement for chronic and special critical diseases in cross provincial outpatient service has brought convenience to patients,with an increasing number of settlement personnel.However,there are still problems such as cumbersome settlement processes,low settlement personnel,ina-bility to settle certain diseases,unclear settlement policies for patients,limited number of medical institutions opened,and inac-curate settlement data.Conclusion Medical insurance departments and institutions at all levels need to work together to develop a unified list of outpatient treatment for chronic and special critical diseases,expand the scope of pilot diseases and medical insti-tutions,optimize settlement processes,strengthen information construction,strengthen policy promotion and personnel training,establish a regulatory mechanism of outpatient treatment for chronic and special critical diseases in remote locations.
