| 引用本文: |
王丽娜,梁丽蕙,王煜昊,等.德国跨州就医及欧盟跨境医疗对我国的启示*[J].中国卫生经济,2023,42(11):88-91.[点击复制] |
Wang Lina,Liang Lihui,Wang Yuhao,et al.Enlightenment of the Cross-State Healthcare in Germany and EU Cross-Border Healthcare to the Supervision of Med⁃ ical Insurance Fund for Cross-provincial Healthcare[J].CHINESE HEALTH ECONOMICS,2023,42(11):88-91.[点击复制] |
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| 摘要: |
| 目的：借鉴德国跨州就医和欧盟跨境医疗管理经验，为完善我国跨省异地就医基金监管提供新思路。方法：结合我国跨省异地就医管理现状，对比分析德国跨州就医管理情况，并围绕欧盟883/2004号条例，从人员资质审核、结算管理等方面对欧盟跨境医疗管理进行剖析。结果：德国内部具备较高的统筹层次，实现患者在德国境内的自由就医，其内部异地就医监管问题并不突出；而欧盟跨境医疗对人员资质审核较为严格，且结算方式多样，对基金支出能够起到一定的“把关” 作用。结论：基于德国跨州就医和欧盟跨境医疗管理经验，建议从提高统筹层次、加强人员流动管理以及拓展手工报销新模式方面完善我国跨省异地就医医保基金监管。 |
| 关键词: 德国跨州就医 欧盟跨境医疗 跨省异地就医 医保基金监管 手工报销 |
| DOI： |
| 投稿时间：2023-09-08 |
| 基金项目:国家自然科学基金面上项目 （72074220） |
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| Enlightenment of the Cross-State Healthcare in Germany and EU Cross-Border Healthcare to the Supervision of Med⁃ ical Insurance Fund for Cross-provincial Healthcare |
| Wang Lina,Liang Lihui,Wang Yuhao,Xu Wei |
| (s School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198 ,China) |
| Abstract: |
| Objective: To draw on the experience of cross-state healthcare within Germany and the EU cross-border healthcare management to provide new ideas for improving the supervision of medical insurance fund in China. Methods: Combining the current situation of cross-provincial healthcare management in China, it compares and analyzes the management of cross-state healthcare in Germany, and explores the EU cross-border healthcare management in terms of personnel qualification audit and settlement manage- ment around EU Regulation 883/2004. Results: Germany has a high level of health insurance coordination, which enables patients to receive medical treatment freely within Germany, and the problem of regulating cross-state healthcare is not prominent; while the EU cross-border healthcare t has a strict qualification check for personnel and various settlement methods, which can play a certain role of “gatekeeper” for fund expenditure. Conclusion: Based on the management experience of cross-state healthcare in Germany and cross-border medical treatment in the EU, it would improve the supervision of China’s interprovincial medical insurance fund in terms of improving the level of coordination, strengthening the management of personnel flow and developing new modes of manual re- imbursement. |
| Key words: Cross-State Healthcare in Germany EU Cross-Border Healthcare cross-provincial healthcare medical insurance fund supervision indirect reimbursement |
