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4类人跨省异地就医直接结算 次均用时仅10秒

2017-09-27 02:40:42   新京报

唐霁松说,将继续扩大异地就医直接结算定点医疗机构数量,在三级医疗机构已基本入网的基础上,逐步将更多符合条件的基层医疗机构纳入异地就医直接结算范围。

“不会导致无序就医”

跨省异地就医直接结算是否意味着医保全国漫游,形成无序就医的局面?对此,人社部医疗保险司副司长颜清辉表示,跨省异地就医直接结算,主要是为了解决参保人员合情合理的异地就医时碰到的跑腿、垫资问题。

颜清辉表示,跨省异地就医直接结算并不意味着医保实现了全国漫游,如果医保全国漫游,必然会在一定程度上导致无序就医,这不是我们的追求目标。

释疑1:哪些人可以从中受益?

目前覆盖异地安置退休人员、异地长期居住人员等四类人群

人社部医疗保险司副司长颜清辉介绍,跨省异地就医直接结算政策可用“就医地目录、参保地政策、就医地管理”15个字概括。“就医地目录”指参保人员跨省就医时原则上执行就医地的支付范围,包括基本医疗保险的药品目录、诊疗项目和服务设施标准。“参保地政策”指参保人员跨省异地就医原则上执行参保地的支付政策,包括医保基金的起付线、支付比例和最高支付限额。“就医地管理”指参保人员跨省异地就医时,就医地经办机构要为异地就医人员提供和本地参保人员相同的服务和管理,包括咨询服务、医疗信息记录、医疗费用审核等。

“比如,一个符合条件的河北某市的参保人员到北京就医,看病时执行的是北京的目录,但是基金支付的起付线、支付比例和最高支付限额还是执行河北所在市的政策。同时,他到北京就医,北京市经办机构要向对待本地参保人一样,给他提供同样的服务和管理。”颜清辉说。

政策将覆盖各类基本医保制度,人社部保险事业管理中心主任唐霁松说,覆盖人员目前包括异地安置的退休人员、异地长期居住人员、常驻异地工作人员(比如有一些驻外办事处,这些员工长期在外工作)和异地转诊人员。

“一些地方还将符合条件的异地急诊住院纳入转诊范围。现在还有很多种情况都在开展,比如回原籍居住的退休知青,原来在某一个地方,现在回到原籍,但是他参保地还在原来的地方。比如在北京,随子女居住,帮带孩子的老年人,以及当地医疗机构诊断不了,或者可以诊断但水平有限,需要到外地、外省就医的患者,都是异地就医直接结算的受益者。”唐霁松说。

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