Researches on Appointed Medical Institution Management in Medical Insurance Supply Chain
|Course||Social Medicine and Health Management|
|Keywords||medical insurance medical insurance supply chain supply chain management appointed medical institution dynamic management mechanism|
Because of the speciality of medical service such as the uncertainty of the medical process, information asymmetry and moral hazard, the management of medical institutions propose a high professional requirements. With the coverage of medical insurance gradually expanding, the number of insured persons increasing, the appropriate medical service to the patient in appropriate time and place is necessary, thus, medical insurance agencies at different levels need to strengthen the effective management of appointed medical institution, to comprehensively improve the satisfaction of insured.By comparing the management status of domestic and international on appointed medical institutions, this article reveals the problems and reasons of our appointed medical institutions management, considering the complex tripartite relationship of medical institution, insurance and patient, and the specialty of medical services market, referring the theory of supply chain management to understand and define the tripartite relations of medical institution, insurance and patient, constructing a three-level network structure model of "medical insurance supply chain". And through establishing a strategic cooperative relationship model of health insurance agencies and appointed medical institutions to coordinate the medical insurance supply chain. Finally, discuss the "choice, appraisal, elimination, development" management mechanism and optimize method of appointed medical institution, mainly study the design of selection standard and method, evaluation index and method of appointed medical institution. The construction and implementation of medical insurance supply chain, conducive to standardization of medical services and implement of medicare database, web-based information sharing technology. Further build a favorable platform for mutual recognition of remote medical treatment and implementation of medical insurance national network.Results show that, from the perspective of supply chain management study the tripartite relations of medical institution, insurance and patient, use medical care market supply-demand relation to pull production and management of this supply chain, will help to break the deadlock three fragmented, help to define the management, incentive and self-restraint standards of appointed medical institutions, while ensuring the medical expense settlement and the safety operation of medical insurance fun, meet patients’ medical needs.Currently, basing gradually reduce the off-site medical treatment barriers and seek national health insurance, supply chain management has special organizational functions such as dynamic and beyond geographical space and administrative regions, conducive to the realization of medical resources across physical space and break the administrative jurisdiction, according to the needs of health care for different dynamically optimized.