Problems and countermeasures of the management of medical insurance settlement list in a province
10.3760/cma.j.cn111325-20240530-00446
- VernacularTitle:某省医保结算清单管理存在的问题及对策分析
- Author:
Yi SHI
1
;
Ruijia LI
;
Lihua LUAN
Author Information
1. 昆明市延安医院病案管理科，昆明 650051
- Publication Type:Journal Article
- Keywords:
Medical security;
Medical insurance settlement list;
Medical institutions;
Diagnosis related groups;
Existing problems;
Countermeasures analysis
- From:
Chinese Journal of Hospital Administration
2024;40(12):977-980
- CountryChina
- Language:Chinese
-
Abstract:
The standardized management of medical insurance settlement list is very important to ensure the rational use of medical insurance funds. In March 2024, this study summarized the problems in the design, implementation, and promotion of the medical insurance settlement list based on expert interviews on the management of the medical insurance fund settlement list, as well as on-site investigations of 46 designated medical institutions in a province. These issues included incomplete design of reporting items that do not fully meet actual needs, inconsistent data collection formats, unclear main responsibilities and workflow of designated medical institutions, inconsistent reporting and information interface standards across regions, limited functionality of medical insurance settlement lists, lack of unified pre verification rules, and incomplete supporting systems. In response to these issues, this study proposed to strengthen the standardization and design of the medical insurance settlement list, clarify the main responsibilities and expand the functions of the list, add pre quality control rules, and improve supporting systems, so as to provide references for promoting the standardized management of medical insurance settlement lists in medical institutions of China.
