摘要由于我国地域辽阔，各个地区经济发展不同步并且发展水平差距很大，经济发展的不平衡导致了全国各地人口大量流动，医疗保险异地就医逐渐成为了一个普遍现象，同时异地就医结算问题也日渐凸显。当前我国异地就医结算管理服务中存在着不少问题，例如我国医疗保险统筹层次低、报销仍旧需要患者参保地与就医地两地跑、报销周期长等，有些地区还出现了医疗资源分配不均衡、使用不合理的问题，同时由于监管不到位导致的骗保行为仍旧常见。针对目前发现的一些问题，根据我国的现实国情，本文提出了以下几个建议：完善医保关系转移体制、提高统筹层次、完善信息系统建设以及加强对医保报销程序监管等，希望能对我国医疗保险异地就医结算管理工作有一定的帮助。86759

毕业论文关键词：基本医疗保险；异地就医；异地就医即时结算；

The Research of a Long-distance Medical Treatment and Settlement in Urban and Rural Basic Medical Insurance

Abstract Due to the vast area of our country, there are differences between the regional economic development and the development level disparity is length。 Economic development imbalance led to large population flows across the country, then settle accounts of off-site medical treatment in urban and rural basic medical insurance has become a common phenomenon。 There are many problems in the long-distance medical settlement services in our country。 such as, the pool level in medical insurance in our country, patients with submit an expense account still need to go both hospitals and insured place, apply for reimbursement is lengthy and complex and so on。 The inappropriate use of medical resource allocation imbalance problem also appeared in some areas; at the same time due to inadequate supervision of insurance fraud behavior is still common。 Aiming at some problems as well as our country's realistic national condition, this paper analyzes the relationship between transfers, such as perfect health care system, improve the overall level, perfecting the information system construction, and strengthen the regulation reimbursement procedures, hope it helps in medical insurance of our country long-distance medical billing management。

Keywords: Basic Medical Insurance；A Long-distance Medical Treatmentl；A Long-distance Medical Treatment and Settlement

目录

0引言1

1相关概念的界定和理论阐述1

  1。1基本概念的界定1

1。2 理论阐述 4

2城镇基本医疗保险异地就医管理现状分析5

  2。1我国城镇基本医疗保险参保现状5

  2。2我国流动人口参加城镇基本医疗保险的情况分析6

  2。3我国城镇基本医疗保险异地就医结算管理现状7

  2。4异地就医结算试点9

3城镇基本医疗保险异地就医结算服务中存在的问题10

  3。1 医保分割管理不利于医保制度的可持续发展11

  3。2 医疗保险统筹层次低11

  3。3 缺乏统一的全国医保信息系统12

  3。4 过分强调异地就医导致“马太效应”13

  3。5 异地医疗行为监管不到位13

4完善我国城镇基本医疗保险异地就医结算管理的建议14

  4。1完善患者医保关系转移体制14

4。2 在发展区域经济的基础上提高统筹层次15

  4。3 积极进行技术研发，完善信息系统建设16

  4。4 循序渐进，处理好医疗资源的利用问题16

4。5 加强监管，探索医保基金审计新思路17

结论19

致谢20

参考文献21

基本医疗保险异地就医结算问题研究