社区卫生服务在医保总额预付制改革中面临的管理挑战

上海自2006年以来在试点区县实施了"医疗保险费用总额预付制"的改革,作为社区卫生服务机构在医保结算方式、内部运行管理、社会满意度提升等方面面临诸多挑战,在执行新型的医疗保险制度管理方式时,作为管理者要及时转变思想,做好积极应对,重点抓好内部医保数据监测及调控、药品结构管理,建立良好的内部考核机制等,才能够不断地适应和推进新一轮的社区卫生服务改革。

Management Challenges of Prepaying System Reform on Total Amount of Medical Insurance in Community Health Services

The reform on prepaying system of total amount of medical insurance has been put into practice in several pilot districts of Shanghai since 2006.Community health service institutes has faced many challenges in such respects as settlement way,internal operation management and improvement of public satisfaction.In implementing new medical insurance system,the manager should change his mind timely,be ready to actively work,put the emphasis on monitoring and regulating the data of internal medical insurance and drug structure management,and set up a good system of check on performance of the internal stuff.Thus a now run of community health service reform can be constantly carried out.