三甲医院医保管理工作的难点及对策研究简

通过医院和参保人两个途径对相关人员进行医院医保管理工作的调研，指出三甲医院医保管理工作存在有事实依据取证和处罚难、实时有效的监督和控制难、规范化管理监管难、参保对象的期望值与实际差距较大等4个方面的难点，进而提出完善政策体系，优化宣传策略、建立医保“一站式”服务体系、联合其他定点医院共同协议管理、设立监督岗位，强化监管力度等建议。

Difficulties and measures on medical insurance management in top tertiary hospital

Based on the investigation of medical insurance management in hospital, 4 problems can described as difficult to take the evidence and punish, difficult to real time monitoring and control, difficult to regulation and the significant gaps between patient＇s expectation and actual compensation. Suggestions such as perfecting policy system, strengthening propaganda, setting one step medical insurance service system, contract management, setting full time supervision post and strengthening regulation.