摘要
分析了某院126例医保费用投诉案例,总结其产生的4种原因:患方对医保政策理解有误(57.1%);医方职责落实不到位(25.4%);医方不合理收费及计价操作失误(8.0%);保方调整医保项目目录及自付比(9.5%)。同时针对纠纷产生的原因提出防范错施:加强宣传教育;增强服务意识;加强监督检查;加强收费管理;加强沟通协调;加强投诉管理等。
In this paper, 126 cases of Medical Insurance cost complaint were analyzed. The complaint reasons were summa- rized as follows ： patients＇understanding to medical insurance policy （ 57.1% ） ; insufficient fulfillment of nosocomial responsibility （ 25.4% ） ; irrational charge or price manipulate lapses of hospital （ 8.7% ） ; and adjustment for medical insurance item catalogue or payment ratio of MI control agency （9.5%）. In view of these, containment measures were proposed including to strengthen propaganda and instructions, strengthen sensitive services, strengthen monitoring and inspect, strengthen administration of charge, strengthen communication and coordination and strengthen administration of accuse inform.
出处
《中国卫生质量管理》
2012年第2期40-41,46,共3页
Chinese Health Quality Management
关键词
医疗保险
医疗费用
投诉原因
防范
Medical Insurance
Health Care Cost
Complaint Reason
Containment
