Summary of the work of hospital medical insurance in 2019

In 2019, under the great attention of the leaders of our hospital, in accordance with the work plan arranged by the Medical Insurance Bureau, following the overall thinking of “grasping the spirit, thoroughly pursuing the policy, vigorously propagating, steadily advancing, and paying attention to implementation”, the work was carried out earnestly. The joint efforts of medical staff in the hospital, the medical insurance and the new rural cooperative medical work in our hospital have achieved certain results. The work of the medical insurance department of our hospital is summarized as follows:

First, the leadership attaches great importance to the publicity

In order to standardize the behavior of diagnosis and treatment, control the unreasonable growth of medical expenses, and ensure the healthy and sustainable development of medical management with low prices and high-quality services, the leadership of our hospital attaches great importance to the unification of ideas, clear goals, and strengthen organizational leadership. A hospital health insurance management committee with the overall responsibility of the “number one” was established. The medical dean's specific leadership team for medical insurance work. The clinical departments have set up a working group with the director of the department as the leader and the head of the nurse as the deputy leader. They are responsible for the overall management of the medical insurance and the rural cooperative work of the university, and are responsible for the specific implementation of the medical insurance system of the university and the implementation of the reward and punishment system.

In order to enable the cadres and workers to have a deeper understanding and comprehensive grasp of the new medical insurance policies and systems, we have carried out extensive publicity, education and learning activities. First, we will hold a staff meeting and a middle-level cadre meeting to explain new medical insurance. Policies, using the form of meetings to deepen everyone's understanding of health care work. The second is to hold medical insurance knowledge training classes, blackboard newspapers, dissemination of publicity materials, and closed-book examinations to enhance the ability of employees to operate their daily work. The third is to strengthen the hospital information management, with the help of the hospital information center, through the medical insurance software management, can be more standardized and more convenient. Greatly reduced the occurrence of errors. The fourth is to promote the medical insurance policy through TV albums, so that the majority of medical insurance personnel, urban residents, students and other friends can truly understand the benefits of participating in the insurance, understand the operation mode of the second hospital , and actively participate in medical insurance activities.

Second, effective measures, strict regulations

In order to make medical insurance and rural cooperative patients "clearly and clearly seek medical treatment, and clearly understand consumption", our hospital first announced the medical insurance, rural cooperative medical treatment flow chart outside the hospital, medical insurance, rural medical patients hospitalization instructions, so that the insured patients can see at a glance. And arrange full-time medical guidance in the hall, responsible for providing medical insurance policy advice to relevant patients. The second is to configure a computer touch screen and electronic display screen to publicize the charging items, charging standards and drug prices, and accept the group supervision. The third is to fully implement the “one-day list system” for inpatient expenses, and require patients or family members to sign the list, and implement a public disclosure system for medical insurance accounts and consciously accept supervision. Make hospitalized patients understand the consumption clearly. When the leaders of the province and the leaders of the Municipal Price Bureau came to the hospital for inspection, they were fully affirmed. Fourth, the hospital medical insurance management committee has formulated regulations for medical insurance management and punishment. The hospital medical insurance management committee is held every quarter to summarize and analyze the problems existing in the recent work, and implement various policy measures. In order to further strengthen the responsibility, standardize the behavior of medical services, regulate the behavior of medical insurance services from the three stages of hospitalization registration, hospitalization, and discharge compensation, strictly implement accountability, and strictly handle relevant responsible persons. Fifth, the hospital staff carried out star-rated services, credit card system, with civilized courtesy, quality service, excellent technology by patients.

In order to grasp the medical insurance work, the hospital combines the actual work. First, the hospital has formulated the management rules and regulations for medical insurance services, and regularly reviews the medical insurance service work plan, and regularly conducts evaluations and formulates improvement measures. The second is to strengthen the management of the ward, often inspect the ward, carry out policy promotion on the bedside, solicit the opinions of the patients, solve the problem in time, check whether there is a hanging bed phenomenon, check whether there is any imposter, and check whether the inpatient has two cards or one card. The required patients, the medical insurance department will not be approved. Strengthen supervision and management of departmental fees and medical staff's diagnosis and treatment, supervise and inspect, promptly and seriously deal with, and report and expose. There were no major mistakes in our department this year, and there were no major violations of discipline and discipline in the hospital.

Third, improve service attitudes and improve the quality of medical care.

The new medical insurance system has brought unprecedented opportunities and challenges to the development of our hospital. It is precisely because of the correct understanding of the medical insurance work that the cadres and workers of the whole hospital are actively involved in this work, and they are responsible for their duties. Each bears its responsibility.

The deputy section chief of our department regularly attends the morning meeting in the ward to timely communicate the new policy and feedback on the medical quality found during the medical insurance review process, understand the clinical medical staff's ideas on the medical insurance system, timely communicate and coordinate, and request all medical staff. Proficiency in medical insurance policies and business, standardize the diagnosis and treatment process, make reasonable inspections, rational use of drugs, eliminate random inspections, large prescriptions, human feelings and other irregular behaviors, and promptly pass the unqualified medical records to the responsible doctor for revision. By paying close attention to medical quality management and standard operation, it has purified the unreasonable charging behavior of medical treatment, improved the management and medical insurance awareness of medical personnel, and improved the quality of medical care to provide a good medical environment for the insured.

In the process of handling medical insurance for employees and participating in the procedures for farmers, my window staff actively promoted to each insured employee and participating farmers, explaining the relevant provisions of medical insurance, the relevant policies of the new rural cooperative medical system, and various subsidy measures. Seriously answer all kinds of questions raised, and strive to prevent an insured patient or family from leaving with dissatisfaction and doubts. Always put "quality and efficient services for insured patients" to the top priority. During the operation of medical insurance, the majority of patients participating in the insurance and participating patients are most concerned about the compensation of medical expenses. In line with the service tenet of “convenience, efficiency, cleanliness and standardization”, our staff strictly control, operate in a friendly manner, implement one-stop service, and honor the medical subsidy expenses on the spot, which greatly improves the satisfaction of participating.

Fourth, the work summary

Through the joint efforts of our staff and the relevant staff of the whole hospital, we worked hard and sincerely served the patients and successfully completed the tasks set at the beginning of the year. In 2019, the inpatients of medical insurance and residents' medical insurance were included, and the total cost was over 10,000 yuan. The reception will be designated as a retired cadre in the hospital, a municipal-level leading cadre, and a disabled soldier. In 2019, the total number of people in the hospital was 100 million yuan, and the direct replenishment was 10,000 yuan, which greatly reduced the burden of medical treatment for the people.

The better departments that have been done in medical insurance and rural cooperative work this year are:

In the process of medical insurance and farmer's work in our hospital, we received the strong support of the leaders of the Municipal Medical Insurance Bureau, the Health Bureau, the Joint Management Office, and the staff. Together with the correct leadership of the leaders of the hospital and the strong cooperation of the medical staff of the hospital, the medical insurance was made. The rural cooperative work has been carried out smoothly. Although some achievements have been made in the work in 2019, there are still some shortcomings, such as: the specific rules for the implementation of the new rural cooperative medical system are not clear enough, the software system is not mature enough, the problems are trivial, and the personnel are nervous, which leads us to be passive in our work. Communication and coordination resistance is too large; the hospital's medical insurance work feedback will be less.

In the future work, it is necessary to strictly control the policy, start with the details, earnestly sum up the experience, constantly improve the various systems, carefully handle the relationship between the internal operation mechanism and the external window service, standardize the business process, simplify the procedures, and strive to be more More and better serve the medical insurance farmers, and strive to push the hospital's medical insurance and agricultural work to a new height, and contribute to the smooth development of the city's medical insurance and rural cooperative work.

Fifth, the main points of the next step

1. Strengthen the quality management of medical services such as medical treatment and compensation, and establish an active, scientific, reasonable, simple and easy reimbursement work program to facilitate the people and win the trust of the people.

2. Coordinate with the medical insurance bureau.

3. Strengthen the publicity of medical insurance policies for hospital medical staff, and regularly provide medical staff with feedback on medical insurance work.