欧盟跨境就医管理模式对中国跨省异地就医的经验借鉴

随着欧洲一体化进程的深入,如何有序管理公民在各成员国之间跨境就医成为欧盟一项重要议题。多年来欧盟社会医疗保险在保障患者跨境就医上已建立一套较为完善的管理模式并受到全世界关注,其社会保障的实践对我国跨省异地就医管理具有借鉴意义。本研究通过系统梳理欧盟跨境就医管理模式,并着重比较欧盟与中国在异地就医对象、异地就医授权、服务机构、就医服务类型、异地医保报销五个方面的异同,为进一步完善我国跨省异地就医管理提供经验借鉴。本研究建议,各省应同步推进跨省就医政策,加快相关工作的落实;增强参保地医保管理机构的审核权限和能力以构建有序就医秩序;同时,在严格审核下拓宽更加合理的跨省就医服务机构网络;最后,鉴于医保对异地就医机构行为缺乏了解,应通过国家异地就医网络,加强医疗机构提供异地就医服务中的监管。

Experience and reference to China's trans-provincial healthcare from European cross-border healthcare management

With the development of integration process, how to manage citizens'' cross-border healthcare between member countries in an organized way has become a major agenda for European Union (EU). Through great efforts over years, a well-functioning mechanism has been established by EU''s social health insurance and has been of global interest. It''s believed that China''s trans-provincial healthcare management can learn a lot from this mechanism. This study aims to provide experiences and reference to China''s trans-provincial healthcare management by overview EU''s mechanism for cross-border healthcare and then analyzing the differences between China and European Union in terms of object of management, authorization, service institutions, types of healthcare services, and reimbursement of medical insurance in different places. This study suggests that it''s necessary for each province to officially introduce relevant policies in order to speed up and facilitate the establishment of trans-provincial healthcare management mechanism. Moreover, to achieve orderly seeking medical treatment, health insurance agencies should be endowed with approval power to authorize patient trans-provincial application. Meanwhile, the network of health institutions which are entitled to provide services to trans-provincial patients should be expanded. Along with such expansion, and given the lack of understanding on behaviors of health institutions in different provinces for a specific local health insurance agency, it''s required that national trans-provincial healthcare management system should take an active role in putting such health institutions under supervision.