Pa Seputembala 5, State Medical Security Bureau idapereka Chidziwitso cha State Medical Security Bureau pa Kuchita Ntchito Yabwino mu Management of Medical Consumables Payment for Basic Medical Insurance (pambuyopa yomwe imatchedwa "Chidziwitso"), yomwe ili ndi 4 zazikulu. zigawo ndi zolemba 15.Zinthu zogwiritsidwa ntchito pachipatala zomwe zatchulidwa mu Chidziwitso ndi zomwe zidalembetsedwa kapena kusungidwa ndi akuluakulu a zida zamankhwala, zapatsidwa mndandanda ndipo zitha kulipiritsidwa padera.
Malinga ndi Chidziwitsochi, kuyambira tsiku lomwe Chidziwitsochi chinaperekedwa, zigawo zikuyenera kufotokozera Bungwe la State Medical Insurance Bureau kuti lipeze mbiriyo asanakhazikitse buku lazachipatala kuti ligwiritsidwe ntchito.Madipatimenti a inshuwaransi yazachipatala akuchigawo akulimbikitsidwa kuti atenge mawonekedwe a mgwirizano wachigawo kapena mgwirizano kuti afufuze kukhazikitsidwa kwa kabukhu kogwirika kogwiritsidwa ntchito ndi njira zolipirira mumgwirizano kapena dera.Bungwe la NHPA likhazikitsa ndondomeko yokonza kalozera wa zinthu zonse zachipatala za inshuwaransi yazachipatala pakapita nthawi.
Mfundo zazikuluzikulu zafotokozedwa mwachidule pansipa:
Mfundo 1: Limbikitsani mgwirizano wadziko lonse wamagulu ndi ma code of consumables
Chidziwitsochi chimanena kuti magulu ndi ma code azinthu zogwiritsidwa ntchito pachipatala ziyenera kugwirizanitsidwa.Kulimbikitsa mwamphamvu kugwiritsa ntchito code inshuwaransi yazachipatala yadziko lonse, munthawi yake molingana ndi National Health Insurance Bureau kuti ikhazikitse magulu azinthu zomwe zimagwiritsidwa ntchito pazachipatala ndi nkhokwe kuti achite ntchito yabwino yokonzanso kachidindo kazachipatala kuti apititse patsogolo kagwiritsidwe ntchito ka kulondola ndi kukhazikika kwa ma code a consumables azachipatala kuti akwaniritse zinthu zomwe zimagwiritsidwa ntchito pachipatala ndi zogula, ndi code yoti mugwiritse ntchito, ndikulipira ma code, kuyang'anira ma code, ndikuwonetsetsa kuti gulu la zinthu zomwe zimagwiritsidwa ntchito pachipatala ndi malamulo a mgwirizano wa dziko.
Mfundo yachiwiri: kulekanitsa kagwiritsidwe ntchito kaukadaulo, zogulira ngati izi mumalipiro a inshuwaransi yachipatala
Chidziwitsochi chikuwonetsa kuti kuchuluka kwa zinthu zomwe ziyenera kuphatikizidwa pakulipira inshuwaransi yachipatala.Kutengera kusintha kwa mtengo wautumiki wachipatala "ntchito zaukadaulo ndi kugwiritsa ntchito zinthu mosiyana", kulimbikitsa ntchito yamtengo wapatali yazachipatala ndi kulumikizana kwa zolipira zogulira zogulira, ndipo pang'onopang'ono sizingaphatikizidwe mumtengo wamankhwala amtundu wazinthu zotayidwa. zoperekedwa ndi kasamalidwe ka inshuwaransi yachipatala.
Mfundo yachitatu: zogwiritsidwa ntchitozi sizidzaphatikizidwa muzolipira za inshuwaransi yachipatala
Pankhani yopeza inshuwaransi yachipatala, "Chidziwitso" chimapereka zomwe zimatsatira "zoyambira" zogwira ntchito.Kupeza ndi kasamalidwe ka zinthu zogulira za inshuwaransi yachipatala nthawi zonse kuyenera kumamatira ku "basic" momwe amagwirira ntchito, kuchita zonse zomwe angathe, momwe angathere, ndikuwonetsetsa kuchuluka kwa malipiro ndi malipiro, kuyang'ana kwambiri ntchito yogulira yachipatala. thumba la inshuwaransi, lidzakhala lofunikira pachipatala, lotetezeka komanso lothandiza, zogulira zachipatala zamtengo wapatali pamlingo wolipira inshuwaransi yachipatala molingana ndi njira.Zomwe zimagwiritsidwa ntchito pachipatala zidzaphatikizidwa ndi malipiro a inshuwaransi yachipatala malinga ndi pulogalamuyi.
M'malo mwake, zinthu zachipatala zomwe zili ndi mtengo wotsika wachipatala, mitengo kapena ndalama zochulukirapo kuposa zomwe thumbali lingakwanitse komanso odwala, komanso zida zochiritsira zosachiritsika sizingaphatikizidwe pakulipira kwa inshuwaransi yachipatala.Kwa boma momveka bwino kuti asaphatikizidwe mu kuchuluka kwa inshuwaransi yachipatala yolipira zogwiritsidwa ntchito, tsatirani zomwe zidakhazikitsidwa.
Mfundo 4: kukhazikitsidwa kwapang'onopang'ono kwa inshuwaransi yachipatala common name management
Chidziwitsochi chikuwonetsa kuti State Medical Insurance Bureau iphunzira za kukhazikitsidwa kwa njira yodziwika bwino yoyang'anira zinthu zachipatala pansi pa inshuwaransi yazachipatala, kutengera gulu la zinthu zomwe zimagwiritsidwa ntchito pazachipatala pansi pa inshuwaransi yachipatala, kudziwa mayendedwe oyenera kuwongolera malipiro a inshuwaransi yachipatala, pang'onopang'ono amapanga malamulo otchula mayina amtundu wamagulu osiyanasiyana azinthu zachipatala, ndikulemba dzina lodziwika bwino la inshuwalansi yachipatala monga maziko a sitepe yotsatira pakuwongolera malipiro a inshuwalansi yachipatala.
Pazamankhwala omwe ali ndi mayina odziwika omwe adapangidwa kale, tiyenera kulimbikitsa kasamalidwe kamalipiro a inshuwaransi yachipatala pazamankhwala malinga ndi mayina wamba.Pazinthu zogulitsira zamankhwala zomwe sizinapange dzina lodziwika bwino, gulu lamakono ndi code zidzagwiritsidwa ntchito panthawiyi pakuwongolera malipiro a inshuwalansi yachipatala.
Mfundo 5: Nthawi ya "14th Five-Year", kukhazikitsidwa kwa kabukhu kakang'ono ka inshuwaransi yachipatala yachigawo.
Chidziwitsochi chikuwonetsa kuti kasamalidwe ka kasamalidwe ka zinthu zachipatala kakuyenda bwino.Limbikitsani kukhazikitsidwa kwa njira yabwino yopezera zinthu zachipatala, nthawi ya "14th-Year Five", iyenera kumalizidwa molingana ndi malamulo ofikira kuti atukule chigawocho (magawo odziyimira pawokha, ma municipalities molunjika pansi pa Boma Lapakati) bukhu logwirizana la inshuwaransi yachipatala.
Pa nthawi imeneyi wakhazikitsa chigawo cha ogwirizana inshuwalansi zachipatala mankhwala consumables bukhu la dera, mongoyembekezera zochokera dziko inshuwalansi zachipatala consumables gulu ndi kachidindo, ndipo pang'onopang'ono kwa inshuwalansi zachipatala wamba dzina kasamalidwe kusintha.Pakadali pano sanakhazikitse buku lothandizira zachipatala m'chigawochi kuti liwonjezere kuyesetsa mpaka "14th Five-Year Plan" kuti akhazikitse buku logwirizana lazachipatala m'chigawochi.
Kuti pakhale kasamalidwe kokhwima kwambiri ka zinthu zodyedwa, boma lipanga pang'onopang'ono buku la inshuwaransi yazachipatala yogwirizana, ndikukulitsa pang'onopang'ono kuchuluka kwa kalozera wadziko lonse wophatikizidwa ndi gulu lazogwiritsidwa ntchito.
Mfundo 6: Khazikitsani njira yosinthira yosinthika ndikuwunika mwayi wolumikizana kuti mugulitse zinthu zokhazokha.
Malinga ndi Chidziwitso, chigawo chilichonse chiyenera kukonza zinthu zodyedwa zachipatala, zachipatala, kasamalidwe ka inshuwaransi yazaumoyo, kuunika kwaukadaulo ndi akatswiri ena ndi mabungwe okhudzana ndi mafakitale, kudzera munjira yowunikira yokhazikika, zogwiritsidwa ntchito zachipatala zoyenera kulowa mu bukhuli molingana ndi njira, ndi zotsatira za kuunikaku zidzawululidwa kwa anthu mu nthawi yake.Limbikitsani kuika patsogolo kuphatikizidwa m'ndandanda wa zinthu zomwe zasankhidwa kuchokera kumagulu apakati omwe akugwirizana ndi ndondomeko yolipirira yamakono.Onani mwayi wopeza zinthu zapadera kapena zamtengo wapatali kudzera muzokambirana ndi njira zina.
Kuphatikiza apo, njira yosinthira zomveka zomveka iyenera kukhazikitsidwa.Ganizirani mozama za kupita patsogolo kwaukadaulo wa zinthu zodyedwa pachipatala, kugwiritsa ntchito kuchipatala, mitengo ndi mtengo wake, komanso kukwanitsa kwa thumba la inshuwaransi yachipatala ndi anthu omwe ali ndi inshuwaransi, ndi zina zotero, kuti muzindikire kusintha kwamphamvu kwa mkati ndi kunja.Kubwezeretsanso munthawi yake zofunikira zaukadaulo watsopano, kuchotsedwa kwachipatala kungasinthidwe bwino, kusawunika bwino kwachuma, ndi madipatimenti oyenerera omwe akuphatikizidwa pamndandanda woyipa ndi zinthu zina sizimakwaniritsa zofunikira za inshuwaransi yachipatala.
Panthawi imodzimodziyo, kukhazikitsidwa kwa njira yochepetsera chiopsezo chothandizira kusintha kwa kuchuluka kwa malipiro a inshuwalansi yachipatala, chitetezo cha thumba, chithandizo cha odwala kwa nthawi yayitali yowerengera zolondola, chifukwa cha zoopsa zomwe zingatheke. kukhazikitsidwa kwa ndondomeko, makamaka yokhudzana ndi kusamutsidwa kwa malipiro a mitundu yosiyanasiyana ya njira zina kuti achite ntchito yabwino yotsimikizira chitetezo cha ufulu ndi zofuna za odwala.
Mfundo 7: Pang'onopang'ono sungani ndondomeko yolipira m'chigawo
Chidziwitso chikuwonetsa kuti ndondomeko yolipira iyenera kulumikizidwa ndikuwongoleredwa.Limbikitsani mfundo zolipirira kuti zikhale zasayansi komanso zoyengedwa bwino, ndipo pang'onopang'ono muthetse ndondomeko yolipira mosasamala potengera kugawikana kwa mtengo wamtengo wapatali, ndi malipiro amtundu umodzi kapena malire.
Madera ogwirizana angaganizire zinthu monga kukwanitsa kwa thumba ndi katundu wa inshuwaransi, ndipo malingana ndi momwe zinthu zilili zenizeni zamtengo wapatali kapena mtengo wa mankhwala opangira mankhwala kuti akhazikitse chiŵerengero choyamba cha malipiro akunja.Madipatimenti a inshuwalansi ya umoyo azigawo akuyenera kulimbikitsa mgwirizano, kulinganiza pang'onopang'ono ndondomeko za malipiro ndi chitetezo cha zigawo zophatikizidwa m'chigawochi, ndi kulimbikitsa zigawo zomwe zili ndi mikhalidweyo kuti zikwaniritse mgwirizano m'zigawo mwamsanga momwe zingathere.
Mfundo 8: Kukhazikitsa njira yolimbikitsira ya DRG/DIP synergistic
Limbikitsani zolipirira mokhazikika komanso mwadongosolo.Limbikitsani zigawo kuti zifufuze njira zolipirira zinthu zachipatala za inshuwaransi yazachipatala ndikupanga kusintha kosinthika.Konzani njira yolumikizirana pakati pa zolipirira ndi mitengo yogulira pakati, ndikuwunikanso zolipirira zinthu zomwe zasankhidwa mumagulu apakati pogula molingana ndi malamulo oyenera.Yang'anani zokambilana zopezera mwayi ndi njira zina zodziwira moyenera zolipirira pazamankhwala zamtengo wapatali.Pazinthu zodyedwa zachipatala zomwe zimagwiritsidwa ntchito ndikugwiritsa ntchito mofanana, zida ndi mawonekedwe ofanana, kusinthidwa kwachipatala, ndi kulumikizana kwa kayendetsedwe ka inshuwaransi yachipatala, njira zolipirira zogwirizana zitha kupangidwa.
Gwirizanitsani kukonzanso njira yolipira.Kukhazikitsa njira yotsatsira ma synergistic ndi DRG, kusintha kwa njira zolipirira za DIP ndi mfundo zina kuti zikhale ndi zotsatira zabwino.Ganizirani za kuchuluka kwa malipiro, mulingo wamalipiro ndi mfundo zolipirira zinthu zodyedwa zachipatala mophatikizana, ndi kukonza bajeti yonse ndi mulingo wamalipiro amitundu/magulu a matenda munthawi yake.
Mfundo yachisanu ndi chinayi: zogwiritsidwa ntchitozi zimayang'ana kwambiri kuunikira
Malinga ndi Chidziwitso, njira yowunikira ndi kuwunika kwa inshuwaransi yachipatala iyenera kukhazikitsidwa.Zigawo pafupipafupi pazamankhwala a inshuwaransi yazachipatala m'chigawocho, kulipira thumba la inshuwaransi yazaumoyo, kulemedwa kwa odwala, ndi zina zambiri, komanso kugula pa intaneti, kugulidwa kwapaintaneti, ndi zina zambiri, kuyang'anira, ziwerengero, kusanthula, kuyang'ana kwambiri kugwiritsa ntchito kwachipatala kuposa kagwiritsidwe ntchito ka ndalama ndi kulemedwa kwa odwala pazamankhwala kuti aziyang'anira katundu wolemera.
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Nthawi yotumiza: Sep-11-2023