人社部回应跨省异地就医四问:谁受益?咋办理?
跨省异地就医直接结算进展如何?人社将惠及哪些人群?具体要走什么样的程序?是否意味着医保全国漫游?人社部26日回应并解读了有关跨省异地就医直接结算的四大热点问题。
总体进展如何?部回办理
“全国联网和跨省异地就医结算工作进展顺利,国家异地就医结算系统联通各地。应跨益咋”人社部社会保险事业管理中心主任唐霁松表示,省异用一句比较形象的地医话说,就是问受高速公路已经修通,凡是人社符合条件的参保人员跨省异地就医住院费用都可以借助这一系统实现直接结算,不必先自己垫资再回参保地报销了。部回办理
据介绍,应跨益咋截至9月25日,省异已全面联通所有统筹地区、地医覆盖城镇职工、问受城乡居民各类医保制度,人社服务异地安置退休、部回办理异地长期居住、应跨益咋常驻异地工作和异地转诊四类跨省就医人群,开通了7226家跨省异地就医住院医疗费用直接结算定点医疗机构。
唐霁松透露,已实现跨省住院医疗费用直接结算4.1万人次,基金支付5.6亿元,平均为每人次患者减少垫付1.36万元。9个月来,全国跨省异地就医结算系统运行平稳。
将惠及哪些人群?
跨省异地就医直接结算将惠及哪些人群?对此,唐霁松表示,现在从人群的范围看,全国联网结算工作,最开始的群体是先从参加城镇职工的异地安置的退休人员起步。现在根据工作管理的范围和服务能力,以及人民群众的要求,不断扩大受益群体的范围,努力实现参保人员的全覆盖。
“说得直白一点,无论是在异地长期居住、生活还是工作,还是因客观需要转诊到异地住院,都可以享受医保直接结算。”唐霁松说。
据介绍,从目前进行的已经结算人员的结构分析,异地安置的退休人员占整个人群的39%,异地长期居住人员占10.3%,常驻异地的工作人员,比如一些驻外的办事处等等,或者是在外地的急诊就医人员达到1.6%,异地转诊人员占到49.1%。现在异地就医结算的群体呈现出多样性。
具体要走什么程序?
如何才能享受到跨省异地就医直接结算的便利?人社部给出了“三步走”的程序:先备案、选定点、持卡就医。
人社部社会保险事业管理中心副主任黄华波说,第一步先备案,就是要求参保人员跨省就医之前需要在参保地的经办机构进行备案,经办机构采集必要的信息;第二步选定点,就是说群众需要选择定点医疗机构,现在定点医疗机构每天都在增加;第三步一定要持卡就医。提醒患者一定要用社保卡,要持卡办理入院和结算。
为什么要进行备案,而不是直接持卡就医呢?黄华波解释称,现在之所以把备案作为跨省异地就医直接结算的前置条件,主要是为了提高群众跨省就医的可靠性和成功率。
黄华波表示,从各地的调研和反映情况来看,进行了备案的人员办理异地就医入院登记和出院结算,普遍都比较顺利。而失败的案例,70%左右是因为备案有问题,要么没有备案,要么是这项工作开展以前的备案,没有根据新的要求更新备案信息。
是否意味着医保全国漫游呢?
跨省异地就医直接结算是否意味着全国漫游呢?人社部医疗保险司副司长颜清辉表示,大力推进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的问题,这是全民医保的应有之义。但是,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,无序就医不是我们的追求目标。”颜清辉认为,一方面,无序就会增加就医人员的总体负担,不仅仅是医疗费用的负担,异地就医还包括交通费用,住宿的费用,吃饭的费用,还有看护的费用等等,这些成本都会增加。
另一方面,颜清辉说,无序就医也会进一步加剧看病难、看病贵的问题,试想一下,如果全国人民无论大病小病都跑到大城市、大医院来看,大医院必然人满为患,就会影响真正需要到大医院看病的疑难杂症患者,使得他们难以得到及时有效的治疗。
“要从根本上解决异地就医的问题,还是要加快医疗卫生服务体系的改革,促进卫生资源的合理配置,建立健全分级诊疗制度,使大多数群众能够就近享受到方便、快捷、高效的医疗服务。”颜清辉称。
(责任编辑:产品中心)
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