The medical insurance of Jinan is done and responded " The quota of worker's medical insurance " Four major doubt

The medical insurance of Jinan is done and responded " The quota of worker's medical insurance " Four major doubt
The medical insurance of Jinan is done and responded " The quota of worker's medical insurance " Four major doubt
The medical insurance patient goes to the hospital to see the doctor, but is " kept outside of the door " ,Publication on September 26 of this newspaper <>A draft, cause the strong response in readers. On the 27th, the medical insurance of Jinan is done and responded actively, to understanding in the way of settling account by norm in urban worker's medical insurance, and will strengthen the inspection to the fixed medical organization, the behavior to the prevarication medical insurance patient, will undertake strong enforcement according to relevant regulations. 1.Why limit? It prevent from " implement overall control ago repetition when it is unreasonable in hospital,Jinan be closed being mainly city medical insurance with ' per person time in hospital by quota ' as main fact, set off by and calculated according to number, calculate according to treating the project, one pair of settlement ways accused of of fee of day of bed. " The medical insurance department head in Jinan says, the settlement way of relying mainly on the fact that per person is in hospital the expenses, management is simple, easy to operate, but the loophole is relatively large, cause some hospitals to present decomposing in hospital, phenomenon in violation of rules and regulations of repeating in hospital, excessively checking, excessively using medicine, excessively treating etc., cause a large number of medical insurance pool funds to run off. It is introduced, there are fixed medical organizations of more than 410 of medical insurance, annual medical insurance fund expenditure of first rate hospital of 13 of third grade among them in all in Jinan, accounts for more than 74% of total expenditure of Jinan, the management of the norm, these hospitals, is very essential. "Implement overall control, should just turn into the medical insurance department and manage and manage together for medical insurance department and hospital alone. " This person in charge says, this year, do the clause increasing fund overall control of the pool in the service agreement with comprehensive fixed medical organization of tertiary first grade in medical insurance of Jinan, the person and total amount of expenses are limited certainly to in hospitalling, these restrain from and is directed primarily to unreasonable repetition to make with questions such as decomposing in hospital and unreasonable expenses,etc. in hospital, do it in this way, help to give full play to the function of the hospital in managing, accord with the policies and regulations of country and province related departments too. 2.Is it legal? Gentle can depend on, a lot of places do it in this way The concrete regulation in this respect, the medical insurance of Jinan runs directors to introduce, worked societied department to issue to File No. 23 and society File No. 30 of stupid wealth of 2009 in 1999, propose " improve basic medical treatment and ensure the expense means of payment, explore way of prepaying according to number paying, total value etc. activelying clearly, it is paid the expenses according with medical treatment and ensuring policy and agreement to stipulate in full amount that in time " . It is introduced, besides Jinan in the national vice provincial city, 10 cities have already implemented this kind of settlement way, Qingdao adopted this method since 2003. "The purpose implementing overall control lies in playing a one's own role in hospital, strengthen internal management, local ones that used the medical insurance fund and should use. " This person in charge emphasizes. 3.Is the fund reduced? Generally increase to some extent compared with last year Put forward against some hospitals " The pool fund that the medical insurance is run to the hospital is reduced " Statement,say last medical insurance fund of hospital this year whether total value is to last every hospital expenditure situation in recent years this person in charge, calculate the definite one through science, deduct the unreasonable expenses, compared with last year, not only has not reduced but also generally increase to some extent. In addition, should be responsible for being called, the medical insurance department also plans to adjust funds at some medical insurance pool, reasonable excess expenses that the hospital happens on the premise of carrying out every medical insurance policy conscientiously, can solve appropriately in adjusting funds. 4.How to solve? " each is subcontracting " in the hospital Correct how to solve this difficult problem firmly, recently, departments such as human resources and social security office of Jinan,etc., convene the relevant person in charge about the hospital to hold the forum, communicate and consult on the question that this period of time appear. The municipal office of people's society of Jinan says, will further standardize the management of the medical insurance fund inside the hospital next, correct a few hospitals to implement firmly " Each is subcontracting " In violation of rules and regulations for method,prompt hospital treatment when ensuring by patienting on medical insurance; Strengthen the inspection to the fixed medical organization, find the behavior of the prevarication medical insurance patient, check and verify, deal with according to relevant regulations; Further strengthen and improve the work of medical insurance, set up and amplify medical insurance fund management system and method with complete science.


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