医院管理与医疗保险的关系与利益探讨

发布时间：2018-01-09 09:39

本文关键词：医院管理与医疗保险的关系与利益探讨　出处：《中国医院》2010年02期 　论文类型：期刊论文

【摘要】：医疗保险机构和医院这对矛盾的两个主体,由于其目标的一致性、功能的统一性、运行机制的依赖性、资源的互补性及趋利性、对立统一的长期性,只有紧密配合,互相沟通,互相理解,互惠互利,确立正确的合作伙伴关系,才能真正成为矛盾的统一体。两者之间相互影响,医疗保险有利于医院管理规范化、对医院的经营管理产生深远影响、有利于提升医院的信誉和形象,同时医院管理对医保改革也起到推动作用,包括:控制不合理费用,提高基金使用效率、抑制道德损害行为,扩大社会支持面、在一定程度上依赖于定点医院的合作。双方建立合作伙伴关系需要处理好的主要问题,包括:医疗保险设计思路由控制调整为合作、建立有效的沟通机制、建立双方定期召开协商会议制度,形成谈判机制、制定科学合理的费用支付体系、医院适应医保改革的举措等。同时,医院还要与商业保险公司建立良好的合作关系。
[Abstract]:Medical insurance institutions and hospitals are two contradictory subjects, because of the consistency of their objectives, the unity of function, the dependence of operation mechanism, the complementarity and tendency of resources, and the long-term nature of unity of opposites. Only through close cooperation, mutual communication, mutual understanding, mutual benefit and the establishment of a correct partnership can we truly become an entity of contradiction. Medical insurance is conducive to the standardization of hospital management, the far-reaching impact on hospital management, the promotion of the credibility and image of the hospital, at the same time, hospital management also plays a role in promoting the reform of medical insurance. Including: to control unreasonable expenses, to improve the efficiency of the use of funds, to curb moral damage behavior, and to expand the scope of social support. To a certain extent, it depends on the cooperation of designated hospitals. The main problems that need to be dealt with in establishing a partnership between the two sides include: the design of medical insurance should be adjusted from control to cooperation, and an effective communication mechanism should be established. Establish the system of regular consultation meetings between the two sides, form a negotiation mechanism, formulate a scientific and reasonable payment system, hospital measures to adapt to the reform of health care, etc. At the same time. The hospital must also establish good cooperative relationship with commercial insurance company.
【作者单位】：复旦大学附属中山医院;
【分类号】：R197.3
【正文快照】： 医院是整个卫生行为的主体,又是实施医疗保险制度下各种矛盾汇聚的焦点,医院管理行为的偏差与调整将直接关系到医疗保险运转和发展。医保机构和医院这对矛盾的两个主体,其支和取的不同地位决定了一定程度上两者对立的必然性。但更应侧重于其统一的一面:它们都是为参保人员服

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