上海市工伤保险异地就医医疗费用结算问题研究

发布时间：2018-06-22 11:35

本文选题：异地就医 + 工伤保险　；参考：《上海师范大学》2016年硕士论文

【摘要】：随着我国经济的不断发展,地区与地区之间之间的交流往来越来越密切,外来流动人口日益增多,工伤人员的数量不断增多,工伤保险异地就医人员的需求不断增长。各个统筹地区根据全国《工伤保险条例》陆续制定了相关的地方性的实施办法和操作细则,但始终没有一套统一的、完善的工伤保险异地就医服务管理政策和结算办法,工伤人员在异地就医的过程中以及办理异地就医报销的过程中,出现了不公平,不便捷的现象,造成工伤保险经办机构提供的服务和异地就医人员需求的矛盾十分突出。本文根据工伤保险相关理论、结合上海医保异地就医结算的相关办法和经验,对上海工伤保险异地就医费用结算的现状和特征进行了归纳。通过对实际案例的分析,经办柜面上随机访谈等方法,分析了工伤保险异地就医费用结算存在的问题及其原因。并结合上海医保在异地就医结算方面的成功经验,明确提出了解决工伤保险异地就医结算困境的,有一定可行性的对策方案:建立统一的工伤异地就医结算标准、设立独立的工伤保险经办机构和独立模式以及协作模式、建立全国信息化共享机制,最终使工伤异地就医结算实现全国联网结算的目标。
[Abstract]:With the development of economy in our country, the communication between regions is closer and closer, the floating population is increasing day by day, the number of work-related injury personnel is increasing, and the demand of medical personnel in different places of industrial injury insurance is increasing. In accordance with the National regulations on Industrial injury Insurance, each overall planning region has successively formulated relevant local implementation measures and operating rules, but there has been no uniform and perfect policy and settlement measures for the management of medical services in different places of industrial injury insurance. During the process of medical treatment in different places and the process of medical reimbursement in different places, the phenomenon of unfair and inconvenient appears, which results in the contradiction between the service provided by industrial injury insurance agencies and the demand of medical personnel in different places. Based on the related theory of industrial injury insurance and the relevant methods and experiences of medical treatment settlement in different places of medical insurance in Shanghai, this paper sums up the present situation and characteristics of the settlement of medical expenses in different places of occupational injury insurance in Shanghai. Based on the analysis of actual cases and the methods of random interview on the counter, this paper analyzes the problems existing in the settlement of medical expenses in different places of industrial injury insurance and the reasons for them. Combined with the successful experience of Shanghai medical insurance in the settlement of medical treatment in different places, this paper clearly puts forward some feasible countermeasures to solve the problem of medical settlement in different places of industrial injury insurance: to establish a unified standard for settling medical accounts for work-related injuries in different places. The establishment of independent industrial injury insurance agencies and independent mode as well as the cooperation model, the establishment of a national information sharing mechanism, and finally make the work-related injuries in different places of medical settlement to achieve the goal of national networking settlement.
【学位授予单位】：上海师范大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：F842.616

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