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上海从1996年5月开始实施职工社会医疗保险,经过两年多的实践,资金收支平衡、略有结余,运行平稳,得到了职工、单位和医疗机构的认同与支持。这与其费用结算给付办法是分不开的。 一、医疗保险费用结算给付办法的特点 医疗保险费用给付办法按照经济关系的不同分成两大部分:第一部分是对供方的结算给付办法,即保方如何与医疗机构进行费用结算,体现医疗保险机构与医疗服务供方的经济关系;第二部分是对需方的结算给付办
Since May 1996, Shanghai started implementing social insurance for workers and staff members. After more than two years of practice, the balance of funds has been balanced and a slight surplus has been maintained and the operation has been smooth. It has been endorsed and supported by workers, units and medical institutions. This is not linked to the settlement of their fees and methods. First, the characteristics of the medical insurance fee settlement method Medical insurance fee payment in accordance with the different economic relations is divided into two parts: the first part is the settlement of payment for the supplier, that is, how the insurance company and the medical institutions for the cost of settlement, reflecting the medical insurance Institutions and medical service providers economic relations; the second part is the demand side of the settlement to pay to do