摘要
Abstract
Online self-registration is a significant highlight of service innovation in the smart medical in-surance field of China.However,even if the process has been simplified,it still increases the time cost for pa-tients.Moreover,the differentiated reimbursement benefits and complex settlement procedures after registration al-so affect the fairness and efficiency of cross-regional medical treatment.How to promote the co-construction and sharing of medical insurance has become a hot topic of concern for the public.Based on the stakeholder theory and the theory of holistic smart governance,a holistic smart governance logic framework for direct settlement of cross-regional medical treatment is constructed.Through the analysis of the innovative practice of"deemed registration"for cross-regional medical treatment in the Beijing-Tianjin-Hebei region,it is found that to achieve the convenient medical treatment model of"one code for all"and to promote the"urban integration"process of cross-regional medical treatment services,the following practical problems will be faced:low efficiency of medical insurance set-tlement,insufficient medical insurance funds,the super hospital suction effect,and the asymmetry of rights and responsibilities in medical insurance supervision.To address these challenges,efforts can be made to strengthen platform settlement,fund allocation,cross-regional supervision,and the intelligentization of primary medical treat-ment,to promote the more scientific and safer use of medical insurance funds and to make cross-regional medical treatment fairer and more efficient.关键词
智慧医保/整体智治/医保基金/跨省结算/异地就医直接结算/免备案Key words
Smart healthcare insurance/Holistic smart governance/Medical insurance fund/Cross-pro-vincial settlement/Direct settlement for cross-regional medical treatment/Exemption from filing分类
预防医学
