Our country should design third party's verification system of the hospitalization cost

Our country should design third party's verification system of the hospitalization cost
Our country should design third party's verification system of the hospitalization cost
The verification of the hospitalization cost is a settlement center of the hospitalization cost ' Hereafter referred to as " The settlement center " )An important routine, the medical safety unit controls the unreasonable main means to increase of the hospitalization cost, also reduce great prescription, thorough examination and repeat the main method of unreasonable medical care in hospital,etc.. In controlling the hospitalization cost to increase, a lot of scholars pay much attention to the research of the means of payment of the hospitalization cost, but neglected the research of this key link of checking to the hospitalization cost. How to check the existing problem of the system is designed again to the hospitalization cost of our country, improve the hospitalization cost of our country to check the system should cause the attention of the relevant department Published in the eighth magazine of " Chinese hospital " " The design of third party's verification system of hospitalization cost of our country " In the article, the public health of Capital University of Medical Sciences and Zhang Ling, medical institute's lecturer of family,etc., through verifying content and procedure, analyzing the exposition of reason why the medical insurance refuses to pay to the hospitalization cost of our country, design proposing implementing third party's verification system of the hospitalization cost in our country, offer the reference basis for improving the hospitalization cost of our country and verifying the system. Point out, the hospitalization cost of our country can roughly be summarized to verify the content as five following respect contents at present: (1)Whether the patient has a medical insurance qualification; (2)Whether charge rationally; (3)Whether use medicine rationally; (4)Whether check and treat rationally; (5)Other content, such as check, have patient go to a doctor phenomenon repeatedly, check medical fee individual pay proportion for itself, reach, stipulate, require etc.. The author further points out, the settlement center verifies the hospitalization cost according to certain procedure, and will think the reasonable hospitalization cost will be paid to the medical organization. In our country's urban worker's medical insurance system, hospitalization cost check and hospitalization cost refuse payment, it controls hospitalization costs to be unreasonable to increase, confirm the intersection of medical insurance and the intersection of fund and steady important means effectively. When the medical organization applies for the hospitalization cost to compensate to the safety unit, it is a more common question to refuse payment in medical insurance, among them, there is reason of the medical insurance department, there is a reason of the medical organization too. The hospitalization cost was verified to the bridge where the system connected between safety unit and medical organization, should verify the hospitalization cost from the angle with just neutrality on the basis of respecting doctor's clinical decision. Seeing that of our country hospitalization cost check system have the intersection of person who improve and problem also at present, propose dealing with the hospitalization cost at present to check the system is designed again. First, institutional framework and operation funds are designed. At present, in the urban worker's medical insurance system of our country, the hospitalization cost is checked to be in the charge of the work of all parts and settlement center under the social security office, actually the settlement center is a department of subordinate of the medical safety unit, but not is in status of neutrality, so, it has already determined to check it is the unfair verification from the system that the hospitalization cost of our country is verified, it is the one-sided verification of safety unit. For this reason, propose our country should establish the third party's hospitalization cost to verify the organization. Second, the design again of operating mechanism. Of our country hospitalization cost check in the system should set up the intersection of revision trial and systemming, in order to maintain medical organization and reasonable interests of safety unit, the most important thing is it by defining the rules and regulations of the unity restrain the hospitalization cost from verifying, but not depend on sneaking the rule. Third, make the hospitalization cost and verify the relevant law. The medical insurance system reform of our country should set about to make and issue and force engagement and carry out the law of strength, could promote medical insurance system and hospitalization cost to verify development and completion of the system effectively in this way. Fourth, set up the open and clear system of information. At present, hospitalization cost of our country check message basically in the close state, propose the transparency of information that our country increases the hospitalization cost to check, have rights to know using the whereabouts of insurance premium that oneself pays to join sponsors at least.


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