[1]吴亭瑶,柏 雪.整体性治理视域下异地就医结算管理路径优化研究[J].卫生经济研究,2024,41(08):61-64.
　WU Tingyao,BAI Xue.Study on Path Optimization of Off-site Medical Settlement Management from the Perspective of Holistic Governance[J].Journal Press of Health Economics Research,2024,41(08):61-64.
点击复制

整体性治理视域下异地就医结算管理路径优化研究

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
41
期数:
2024年08期
页码:
61-64
栏目:
医疗保障
出版日期:
2024-08-01

文章信息/Info

Title:
Study on Path Optimization of Off-site Medical Settlement Management from the Perspective of Holistic Governance
作者:
吴亭瑶1; 柏 雪2
1.苏州大学，江苏 苏州 213000
2.常熟理工学院，江苏 常熟 215500
Author(s):
WU Tingyao;  BAI Xue
Suzhou University, Suzhou Jiangsu 213000, China
关键词:
异地就医; 整体性治理; 统筹层次; 监管体系; 经办服务
Keywords:
off-site medical treatment;  holistic governance;  pooling Level;  supervision system;  handling services
分类号:
F840.684
文献标志码:
A
摘要:
我国异地就医结算存在医保政策、监管及经办服务的“碎片化”问题，整体性治理理论和国际实践经验可以为完善我国异地就医结算管理提供优化路径：切实推进分级诊疗政策；以政府为中心，创新监管机制；实现医保结算政策标准化，统筹推进全民医保建设；建立和完善异地就医领域法律法规；推行“综合柜员制”，规范异地就医经办流程；稳步推进信息化建设。
Abstract:
In off-site medical settlement in China, there was the problem of "fragmentation" of medical insurance policies, supervision and handling services. The theory of holistic governance and international practical experience can provide an optimal path to improve the management of off-site medical settlement in China. It is necessary to effectively promote the policy of hierarchical diagnosis and treatment, innovate the supervision mechanism centered on the government, realize the standardization of medical settlement policy to promote the construction of universal medical insurance, establish and improve the laws and regulations in the field of off-site medical treatment, implement the "integrated teller system" to standardize the process of off-site medical treatment, and steadily promote the construction of information technology.

参考文献/References:

[1] 谢莉琴，秦盼盼，胡红濮.多源流理论视角下异地就医结算政策工具的选择逻辑[J].中国医院管理，2023，43（02）：33-35.
[2] 胡宏伟，王红波.整体性治理视域下我国医保体系托底保障功能评估与改进[J].中州学刊，2022（02）：70-9.
[3] 史云贵，周荃.整体性治理:梳理、反思与趋势[J].天津行政学院学报，2014，16（05）：3-8.
[4] 魏来.整体性治理视角下区域医疗机构纵向协作优化研究[J]. 中国卫生政策研究，2019，12（06）：1-8.
[5] 王淑敏，徐赞，崔文虎，等.整体性治理视域下完善医保基金管理的思考[J].卫生经济研究，2022，39（11）：16-18，22.
[6] 刘畅，王宇菲.京津冀异地就医直接结算政策执行偏差问题研究[J].中国医院，2023，27（01）：7-10.
[7] 张录法.门诊费用跨省直接结算的策略与路径——以“长三角”地区为例[J].南京社会科学，2021（06）：70-77.
[8] 谢莉琴，胡红濮.异地就医直接结算政策执行的利益相关者分析 [J].社会保障研究，2021（03）：70-77.
[9] 朱凤梅.我国基本医保省级统筹的政策选择——基于国际经验的视角[J].中国医疗保险，2021（04）：72-80.
[10] 刘璐婵.流动人口跨省异地就医困局的缘起、政策分析与制度破解 [J].四川轻化工大学学报（社会科学版），2020，35（05）：31-47.
[11] 袁涛.基本医疗保险省级统筹的科学内涵与路径优化[J].中州学刊，2022（12）：85-94.
[12] 刘阳，李亚子，孙异凡.跨省异地就医直接结算资金周转模式分析及优化路径[J].中国卫生经济，2020，39（01）：34-37.
[13] 翁惠芬， 张一凡，刘宝.欧洲跨境医疗服务及其数字化[J].中国卫生资源，2021，24（06）：820-825.

相似文献/References:

[1]冯海欢,李天俊,滕世伟,等.异地就医联网结算医保病人特征聚类分析[J].卫生经济研究,2018,(07):51.
[2]孙弋涵,沈 晓,徐一明.基于整体性治理理论的县域医共体建设研究——以湖北省为例[J].卫生经济研究,2020,(10):24.
　SUN Yi-han,SHEN Xiao,XU Yi-ming.Study on the County-level Medical Alliance Construction Based on Integration Governance Theory——Take Hubei Province as an example[J].Journal Press of Health Economics Research,2020,(08):24.
[3]许正圆,徐 伟,黄晓青,等.长三角地区异地就医门诊费用直接结算现状、模式及难点[J].卫生经济研究,2022,39(2):70.
　XU Zheng-yuan,XU Wei,HUANG Xiao-qing,et al.The Current Status, Model and Difficulties of Immediate Settlement for Off-Site Outpatient Medical Care in The Yangtze River Delta Region[J].Journal Press of Health Economics Research,2022,39(08):70.
[4]王淑敏,徐 赞,崔文虎,等.整体性治理视域下完善医保基金管理的思考[J].卫生经济研究,2022,39(11):16.
　WANG Shumin,XU Zan,CUI Wenhu,et al.Reflections on Improving the Management of Health Insurance Fund from the Perspective of Holistic Governance[J].Journal Press of Health Economics Research,2022,39(08):16.
[5]袁 笛.我国长期护理保险的整体性治理研究——基于成都市试点经验[J].卫生经济研究,2024,41(02):31.
　YUAN Di.Study on Holistic Governance of Long-term Care Insurance ——Based on the Pilot Experience of Chengdu City[J].Journal Press of Health Economics Research,2024,41(08):31.
[6]刘家宇,张 媚,袁小丽,等.整体性治理视域下医改监测病种（组）筛选方法及建议[J].卫生经济研究,2024,41(04):10.
　LIU Jiayu,ZHANG Mei,YUAN Xiaoli,et al.Screening Methods and Suggestions for Monitoring Disease Groups of Healthcare Reform under the Perspective of Holistic Governance[J].Journal Press of Health Economics Research,2024,41(08):10.
[7]姬雄华,邓 慧.农村医养结合整体性治理及其实现路径[J].卫生经济研究,2025,42(03):6.
　JI Xionghua,DENG Hui.Holistic Governance of Rural Integrated Elderly Care and Medical Services and its Implementation Path[J].Journal Press of Health Economics Research,2025,42(08):6.
[8]郁雅莉,王高玲.我国老年人长期照护体系高质量发展多元协作框架构建 ——基于整体性治理理论[J].卫生经济研究,2025,42(07):1.
　YU Yali,WANG Gaoling.Construction of Multi-Stakeholder Collaboration Framework for the High-Quality Development of Long-Term Care System for the Elderly in China ——Based on Holistic Governance Theory[J].Journal Press of Health Economics Research,2025,42(08):1.
[9]于 伟,孙亚玲,郑永菊,等.DIP支付改革对不同就医类型肺癌住院患者的影响研究[J].卫生经济研究,2025,42(08):75.
　YU Wei,SUN Yaling,ZHENG Yongju,et al.Study on the Impact of DIP Payment Reform on Lung Cancer Hospitalized Patients with Different Types of Medical Treatment[J].Journal Press of Health Economics Research,2025,42(08):75.

更新日期/Last Update: 2024-08-01