An analysis of real-time settlement data for offsite medical insurance at a tertiary hospital in Beijing
10.3760/cma.j.issn.1000-6672.2018.04.017
- VernacularTitle:北京市某三级甲等医院异地医保实时结算数据分析
- Author:
Yue JIN
1
Author Information
1. 100730,首都医科大学附属北京同仁医院医保办
- Keywords:
Insurance,hospitalization;
Offsite medical treatment;
Real-time settlement;
Hierarchical medical system;
Medical alliance
- From:
Chinese Journal of Hospital Administration
2018;34(4):337-341
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the present situation and characteristics of the offsite real-time settlement patients based on the statistics of the hospital's information of such patients, for the purpose of work improvement.Methods Retrospective analysis was made on the hospitalization cost and the payment period of 1 151 offsite real-time settlement medical insurance patients in the hospital. Descriptive method was used as the statistical methods to analyze the data. Results The patients came from various places, mainly from Hebei province;most of them aged 51 years or older; mostly covered by medical insurance for urban workers; the largest proportion was retirees; their visits centered on E. N. T. department; the reimbursement policies of various provinces differed sharply, and the reimbursement period tended to be long.Conclusions Senile patients deserve greater attention to improve their service and environment; the hierarchical medical system should play a greater role for rational use of characteristic disciplines; establish the medical partnerships should be based on the Beijing-Tianjin-Hebei integration; greater efforts are required to communicate the medical insurance policy for greater coverage of the beneficiaries; commercial insurance should be introduced in the practice, to relieve the burden of advanced payments on medical institutions;reimbursement policy needs to be consistent,to ensure the fairness and universality of the basic medical insurance system.
