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目的分析医疗保险管理部门现行的管理制度与结算方式下造成拖欠医疗机构医疗保险费用的原因,以寻求更有效的管理方法,缓解双方的矛盾。方法对2001-2008年以来的医疗保险费欠费原因进行回顾性分析,并对城镇职工医疗保险和离休干部医疗保险欠费数据进行分项分析。结果在医疗保险管理部门现行的管理制度与结算方式下,利用其强势地位拖欠医院医疗费用是不合理的,是造成双方矛盾的主因。结论希望医疗保险管理部门制定重大政策时做到公平、公正、公开,并积极加强与医院的沟通,努力推动和谐医保建设。
Objective To analyze the reasons for the arrears of medical insurance under the current management system and settlement method of medical insurance management department so as to seek more effective management methods and ease the contradiction between the two parties. Methods Retrospective analysis of the causes of medical insurance arrears since 2001-2008 was carried out. The data of medical insurance for retired workers and the medical insurance of retired cadres were analyzed separately. Results In the medical insurance management department under the current management system and settlement methods, the use of its strong position to hospital medical expenses is unreasonable, is the main cause of the contradiction between the two sides. Conclusion It is hoped that the medical insurance administration will be fair, just and open when formulating major policies and actively strengthen communication with the hospital so as to promote harmonious medical insurance.