門診特種病、慢性病的審批和報(bào)銷注意事項(xiàng)

董濤軍

[摘要] 目前，門診特種病與慢性病已納入社會(huì)醫(yī)療保險(xiǎn)報(bào)銷范疇，但不同類型的醫(yī)療保險(xiǎn)門診特種病和慢性病的審批與報(bào)銷存在差異，同種醫(yī)療保險(xiǎn)門診特種兵與慢性病的報(bào)銷和審批也有所不同。該文簡(jiǎn)述該院現(xiàn)行醫(yī)療保險(xiǎn)情況以及特種病與慢性病相關(guān)知識(shí)與疾病范疇，介紹了該院門診特種病、慢性病審批與報(bào)銷流程，并針對(duì)審批與報(bào)銷流程中的注意事項(xiàng)進(jìn)行歸納和總結(jié)，旨在為居民門診特種病、慢性病報(bào)銷提供便捷。

[關(guān)鍵詞] 門診;特種病;慢性病;審批;報(bào)銷;流程;注意事項(xiàng)

[中圖分類號(hào)] R19 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1672-5654（2020）01（c）-0060-03

[Abstract] At present， outpatient special diseases and chronic diseases have been included in the scope of social medical insurance reimbursement， but there are differences in the approval and reimbursement of different types of medical insurance outpatient special diseases and chronic diseases. This article briefly describes the current medical insurance situation in our hospital， as well as the special diseases and chronic diseases related knowledge and disease categories， introduces the outpatient special disease， chronic disease approval and reimbursement process， and summarizes and summarizes the precautions in the approval and reimbursement process. It provides convenience for reimbursement of outpatient special diseases and chronic diseases.

[Key words] Outpatient; Special disease; Chronic disease; Approval; Reimbursement; Process; Precautions

醫(yī)療保險(xiǎn)制度是為解決居民治病問(wèn)題而遵照保險(xiǎn)原則進(jìn)行的醫(yī)療保險(xiǎn)基金籌集、分配與使用，是目前國(guó)際普遍應(yīng)用的一種衛(wèi)生費(fèi)用管理模式，是居民醫(yī)療保健事業(yè)有效籌資機(jī)制，能夠通過(guò)個(gè)人或用人單位繳費(fèi)建立醫(yī)療保險(xiǎn)基金，當(dāng)參保人患病后就診產(chǎn)生醫(yī)療費(fèi)用時(shí)，即可通過(guò)醫(yī)療保險(xiǎn)機(jī)構(gòu)獲得一定經(jīng)濟(jì)補(bǔ)償，對(duì)消除疾病帶來(lái)的不安因素、保護(hù)國(guó)民健康、維護(hù)社會(huì)安定具有重要意義。醫(yī)療保險(xiǎn)制度最早興起于歐美國(guó)家，如英國(guó)施行政府醫(yī)療保險(xiǎn)，體現(xiàn)出公平性與福利性，德國(guó)施行社會(huì)醫(yī)療保險(xiǎn)，由多方籌集醫(yī)療保險(xiǎn)基金，美國(guó)施行商業(yè)健康保險(xiǎn)，保險(xiǎn)責(zé)任與權(quán)力又保險(xiǎn)雙方通過(guò)簽訂合同來(lái)規(guī)定，國(guó)家與政府不予干預(yù)。我國(guó)現(xiàn)行醫(yī)療保險(xiǎn)制度分為社會(huì)性與商業(yè)性兩種，其中前者是我國(guó)居民基礎(chǔ)社會(huì)保障之一，包括城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)、城鎮(zhèn)居民基本醫(yī)療保險(xiǎn)等類型。……