社区门诊城镇医保两类人群费用支付分析

目的通过对社区卫生服务中心城镇职工基本医疗保险对固定和非固定在同一社区门诊就医的两类人群进行分析,为实现社区有效医保监管和在家庭医师制度下采取适宜的医保支付方式提供依据。方法采用excel和spss软件对社区卫生服务中心城镇职工基本医疗保险门诊结算数据进行分析。结果医保管理部门应加强对社区门诊固定人群的医保监管,实行社区门诊混合型医保支付方式可有效地提高医保基金的使用效率,使家庭医生的服务更加有针对性。结论加强对社区门诊固定人群的监管可有效提高医保监管效率,同时在家庭医生制度下采取社区门诊两类人群的不同医保支付方式是现行医保制度下较为稳妥和有效的,有利于医保基金的合理使用和家庭医生的更好服务。

Medical Insurance Payment Analysis in Two Populations in the Community Outpatients Health Center

Objective By analyze the two types of outpatients of basic medical insurance for urban workers in community health center, provide the evidence for the realizing of effective medical insurance supervision and take appropriate medical insurance payment to the family physician system, Methods A statistic analysis was made on the outpatients＇ data of the medical insurance for urban workers with the application of SPSS and excel software. Results The medical administrative departments should strengthen the su- pervision of fixed crowd, and carry out application of the hybrid medical insurance payment can effectively improve the medical insur- ance fund, make the family doctor service more targeted. Conclusions We should strengthen the supervision of the fixed crowd which can effectively improve the medical insurance regulatory efficiency, and hybrid medical insurance payment under the family doctor sys- tem of community health center is the better and reliable payment under current medical insurance, which is beneficial to the rational use of medical insurance fund and family doctors better service.