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城镇基本医疗保险住院管理过程中存在的问题主要有:医疗费用逐年增长,医保统筹基金超标;参保人员个人负担较高;医护人员不熟悉医保政策,影响医患沟通;医保信息管理系统不够完善;个别医务人员受自身利益驱使,存在不规范医疗行为。文章提出了对策及建议:建立健全组织领导机构,统一认识;强化学习,教育培训;宣传引导,转变观念;控制费用支出,减轻参保人员个人负担;强化内部管理。
The main problems in the process of hospitalization of basic medical insurance in urban areas are as follows: the medical expenses are increasing year by year, the medical insurance pooling funds exceed the standard; the insured persons have a higher personal burden; the medical staffs are not familiar with the medical insurance policies and the communication between doctors and patients; the medical insurance information management system is not perfect ; Individual medical staff driven by their own interests, there are non-standard medical behavior. The article puts forward countermeasures and suggestions: establish and perfect the organization of leading bodies, unify understanding; strengthen learning, education and training; propagandize and guide, change concepts; control expenses, reduce the individual burden of insured persons; strengthen internal management.