中国农村卫生事业管理2026，Vol.46Issue(4)：245-249,5.DOI:10.19955/j.cnki.1005-5916.2026.04.003
天津市异地就医直接结算现状及优化策略质性研究
A qualitative study on the current status and optimization strategies of direct settlement for cross-region medical treatment in Tianjin
摘要
Abstract
Objective To improve the level of settlement services and to ensure the safety and rational use of national medical insurance funds through a qualitative study on the current situation and optimization strate-gies of cross-provincial direct settlement of medical expenses in Tianjin.Methods The purpose sampling method was adopted.Patients eligible for direct cross-region settlement,their family members,relevant practitioners in five provinces,and national medical insurance practitioners and Tianjin medical insurance practitioners were se-lected as interviewees(n=50)for a semi-structured interview.The subject content analysis was performed in combination with Atlas.ti 8.3 software for encoding and analysis.Results At present,direct settlement of inter-provincial medical expenses in Tianjin was guaranteed by comprehensive work system,practical policies and processes,and superb information technology.However,there were still some problems:First,the filing process was complicated,and there was a lack of training;second,policies varied from place to place,making consistent management difficult;third,there was a big gap in the level of network infrastructure across different regions;fourth,there was a lack of direct and effective monitoring mechanism;fifth,the hierarchical medical service sys-tems were not coordinated.Conclusions The optimization strategies for cross-provincial direct settlement of medi-cal expenses are to change the settlement management mechanism and redefine business responsibilities.关键词
医疗保险/异地就医直接结算/提纲式访谈/内容分析法/质性研究/优化策略Key words
Medical insurance/Direct settlement for cross-region medical treatment/Outline interview/Content analysis method/Qualitative research/Optimization strategy分类
医药卫生引用本文复制引用
吴迪,张冬..天津市异地就医直接结算现状及优化策略质性研究[J].中国农村卫生事业管理,2026,46(4):245-249,5.基金项目
天津市卫生健康事业管理课题(DYKT2025029) （DYKT2025029）
天津市医院协会医院管理研究项目(2024zc094) （2024zc094）
