NgoSepthemba 5, I-State Medical Security Bureau ikhiphe isaziso se-State Medical Security Bureau ekwenzeni umsebenzi omuhle ekuphathweni kwezindleko zezokwelapha ezikhokhelwa umshuwalense wezokwelapha oyisisekelo (lapha kubizwa ngokuthi "isaziso" izingxenye nezindatshana eziyi-15. Ukuthengiswa kwezokwelapha okukhulunywa ngawo kwisaziso yilawo abhaliswe noma afakwe yiziphathimandla zedivayisi yezokwelapha, anikezwe isikhundla sohlu futhi angakhokhiswa ngokwahlukana.
Ngokwesaziso, kusukela ngosuku lokukhishwa kwalesi saziso, izifundazwe kufanele zibike ku-State Medical Insurance Bureau yerekhodi ngaphambi kokwethula ikhathalogi yokudla yezokwelapha yokusebenzisa. Iminyango yomshuwalense wezokwelapha esifundazweni iyakhuthazwa ukuthi ithathe uhlobo lokubambisana kwezifunda noma ukubambisana ukuhlola ukusungulwa kwekhathalogi elihlanganisiwe elihlanganisiwe kanye namazinga okukhokha ngaphakathi kwe-Alliance noma isifunda. I-NHPA izokwethula ukuthuthukiswa kwekhathalogi kazwelonke yokudla kwezokwelapha yomshuwalense wezokwelapha ngokuhamba kwesikhathi.
Amaphuzu asemqoka afingqiwe ngezansi:
Iphoyinti 1: Ukugqugquzela ubumbano lukazwelonke lokuhlukaniswa kanye nekhodi yokudla
Isaziso sithi ukuhlukaniswa kanye nekhodi yokudla kwezokwelapha kufanele kubukwe. Ukukhuthaza ngokuqinile ukusetshenziswa kwe-National Medical Insurance Consure Medical Counsect, ngesikhathi esifanele ngokuya ngeNational Health Insurance Bureau ukuthuthukisa ukuhlukaniswa kwezindleko zezokwelapha kanye nedatha yokwenza umsebenzi omuhle wokuvuselela ikhodi yokudla yezokwelapha ukuze uhlose ikhodi yokudla yezokwelapha ukuze uphinde uhlole ikhodi yokudla yezokwelapha ukuze uphinde uhlole ikhodi yokudla yezokwelapha ukuze uphinde uhlole ikhodi yokudla yezokwelapha ukuze uhlose ikhodi yokudla yezokwelashwa ukuze uthuthukise i Ukusetshenziswa kokunemba nokuma kwekhodi yokudla yezokwelapha ukufeza okudliwayo kwezokwelapha ngokuthengwa kwempahla, nekhodi ongayisebenzisa, nokukhokhiswa kwekhodi, nokuqinisekiswa kwekhodi, kanye ne-Code of ubunye bezwe.
Khomba Okubili: Ukwehlukaniswa Kwezobuchwepheshe, Lolu hlobo lokudla ngokukhokha umshwalense wezokwelapha
Isaziso siveza ukuthi ubukhulu bokudla okuzofakwa ekukhokheni umshwalense wezokwelapha. Ukuzivumelanisa nezinsizakalo zezokwelapha ze-Medical Service Reform "kanye nokusetshenziswa kwezinto ezibonakalayo ukuhlinzekwa kwesilinganiso sokuphatha umshwalense wezokwelapha.
Iphuzu lesithathu: Lezi zinto zokudla ngeke zifakwe emthethweni ekukhokhweni komshuwalense wezokwelapha
Mayelana nokufinyelela kumshuwalense wezokwelapha, "isaziso" sinikeza lokho kunamathela endaweni yokusebenza "eyisisekelo". Ukutholakala nokuphathwa kwezinto eziyisisekelo zomshuwalense wezokwelapha kufanele zihlale zinamathela ngokuqinile ekukhuleni okusebenzayo "okuyisisekelo", zisenze konke okusemandleni, futhi zinqume kahle umkhawulo wamazinga wokukhokha namazinga wokukhokha. Isikhwama Somshuwalense, sizodingeka ngokwemitholampilo, siphephile futhi siphumelele, sinamanani entengo yezokwelapha esilinganisweni sokukhokhwa komshuwalense wezokwelapha ngokuya ngezinqubo. Ukudla kwezokwelapha kuzofakwa esikalini senkokhelo yomshuwalense wezokwelapha ngokuya ngohlelo.
Ngokuyinhloko, ukudliwa kwezokwelapha ngenani eliphansi lomtholampilo, amanani noma izindleko ezidlula kude kakhulu okutholakalayo kwesikhwama neziguli, kanye nemishini yokuvuselela kabusha engeyona yokwelapha ngeke ifakwe kububanzi bokukhokha umshwalense wezokwelapha. Ngoba isimo esidingekayo ngokusobala ukuthi singafakwa kwisilinganiso sokukhokhwa komshwalense wezokwelapha kwezinto zokudla, zinamathele ezinhlelweni zangempela.
Khomba ezine: Ukuqaliswa kancane kancane kwezinto zokuphathwa komshwalense wezokwelapha
Isaziso siveza ukuthi i-State Medical Insurance Bureau izofunda ukusungulwa kohlelo lokuphathwa kwamagama olujwayelekile lokudla kwezokwelapha ngaphansi komshuwalense wezokwelapha, ngokususelwa kulwazi lwezokwelapha ngaphansi komshuwalense wezokwelapha, kuthola imigomo yokuqamba efanelekile ekuphathweni kwe Ukukhokhwa komshwalense wezokwelapha, kancane kancane kwakha imithetho yokuqamba amagama amagama ajwayelekile wezigaba ezihlukile zokudla kwezokwelapha, futhi ahlanganise igama elijwayelekile lomshuwalense wezokwelapha njengesisekelo sesinyathelo esilandelayo ekuphathweni komshuwalense wezokwelapha.
Ukudla kwezokwelashwa ngamagama ajwayelekile asevele wenziwe, kufanele sikhuthaze ngentshiseko ukuphathwa komshuwalense wezokwelapha ngokudla okwenziwe ngodokotela ngokusho kwamagama afanayo. Okokudla kwezokwelashwa okungakakakhe igama elijwayelekile, ukuhlukaniswa okukhona njengamanje kanye nekhodi kuzosetshenziselwa isikhathi sokuphathwa kokukhokha umshwalense wezokwelapha.
I-Point 5: "Isikhathi seminyaka emihlanu" esingu-14 ", ukusungulwa kwekhathalogi enobunye yezokwelapha enobunye
Isaziso sikwenza kucace ukuthi ukuphathwa kokufinyelela kwekhathalogi yokudla kwezokwelapha kuthuthuka ngokuqinile. Nyusa ukusungulwa kohlelo lokufinyelela oluzwakalayo lwezokwelapha, "isikhathi seminyaka emihlanu", kufanele siphothulwe ngokuya ngomthetho wokufinyelela ukuthuthukisa isifundazwe (izifunda ezizimele, omasipala ngqo ngaphansi kokwelashwa komshuwalense wezokwelapha.
Kulesi sigaba sesisungule umkhonzo wezokwelapha ohlanganisiwe wesifundazwe wesifunda, ngokususelwa okwesikhashana kwi-National Medical Insurance Insurance Confinication Medical Consulications and Code, futhi kancane kancane kuguquko lomshuwalense wezokwelapha olujwayelekile. Kulesi sigaba akukezwangasi isiqondisi sezokwelapha esihlanganisiwe sezokwelapha esihlangene sesifunda ukwandisa imizamo yokuthola "isikhathi secebo leminyaka emihlanu" ukusungula inkomba yezokwelapha ehlanganisiwe.
Ukuphathwa okuvuthiwe ngokwengeziwe kokudla okujwayelekile, uMbuso uzothuthukisa kancane kancane ikhathalogi yomshuwalense wezwe onobunye, futhi kancane kancane wandise ubukhulu bekhathalogi likazwelonke elimbozwe isigaba se-contaire.
I-Point 6: Sungula indlela eshukumisayo yokulungiswa futhi uhlole ukufinyelela okuxoxwe ngezinto ezikhethekile
Ngokwesaziso, isifundazwe ngasinye kufanele sihlele okudla kwezokwelapha, emtholampilo, ukuphathwa komshuwalense wezempilo, ukuhlolwa kwezobuchwepheshe kanye nezinhlangano ezihlobene nezokwelapha, ngokudla okufanele kwezokwelapha, ukukhiqizwa okufanele kwezokwelapha okufanele, kanye ne Imiphumela yokuhlola izodalulwa emphakathini ngendlela esifike ngesikhathi. Khuthaza ukufakwa okubaluleke kakhulu kukhathalogi yokudla okukhethiwe kusuka ekuthengeni okuhlanganisiwe okuhambisana nenqubomgomo yokukhokha yamanje. Hlola ukufinyelela kwimikhiqizo ekhethekile noma ephezulu yenani ngezingxoxo nezinye izindlela.
Ngaphezu kwalokho, kufanele kusungulwe inqubo yokulungiswa okunamandla okushukumisayo. Ukubheka ngokuphelele inqubekela phambili yezobuchwepheshe yokudla kwezokwelapha, ukusetshenziswa kwemitholampilo, intengo kanye namazinga wezindleko, kanye nokutholakala kwemali yomshuwalense wezokwelapha kanye nabantu abanomshuwalense, njll., Ukubona ukulungiswa okunamandla kokungena ngaphakathi nangaphandle. Ukugcwaliswa okufika ngesikhathi kwemikhiqizo yezobuchwepheshe emisha edingekayo, ukuhoxiswa kwemitholampilo kungashintshwa kangcono, ukuhlolwa okumpofu kwezomnotho, ngeminyango efanelekile efakwe ohlwini olubi neminye imikhiqizo ayihlangabezani nezidingo zomshuwalense wezokwelapha.
Ngasikhathi sinye, ukusungulwa komshini wokuvimbela ubungozi obuhle kakhulu kokulungiswa kobubanzi bokukhokhelwa komshuwalense wezokwelapha, ukuphepha kwesikhwama, ukwelashwa kweziguli isikhathi eside sokubala okunembile, ngezingozi ze Ukuthuthukiswa kwecebo, ikakhulukazi okubandakanya ukudluliswa kwesilinganiso sokukhokhwa kwezinhlobonhlobo zenye indlela yokwenza umsebenzi omuhle wokuqinisekisa ukuvikelwa kwamalungelo neziguli.
I-Point 7: Kancane kancane ilinganisa inqubomgomo yokukhokha ngaphakathi kwesiFundazwe
Isaziso siveza ukuthi inqubomgomo yokukhokha kufanele ihlanganiswe futhi yenziwe kahle. Gqugquzela inqubomgomo yokukhokha ukuthi ibe yisayensi eyengeziwe futhi yacwengisiswe kancane, futhi kancane kancane isigaba se-sloppy ukukhokha imali ngokusekelwe ekukhokhweni okuhlukanisiwe kwezinga lezindleko, kanye ne-quota yosayizi owodwa noma umkhawulo.
Izindawo ezihlelekile zingabhekisa izici ezinjengokufinyeleleka kwesiKhwama kanye nomthwalo wezomshuwalense, futhi ngokwesimo sangempela samanye amanani aphezulu noma izindleko zokudla kwezokwelapha ukusetha isilinganiso sokuqala sokukhokha esisephaketheni. Iminyango Yezempilo Yezempilo Yesifundazwe kufanele iqinise ukuxhumanisa, kancane kancane ilinganise izinqubomgomo zokukhokha kanye namazinga okuvikela ezifundeni ezihlanganisiwe esiFundazweni, futhi akhuthaze izifundazwe ngemibandela yokubandakanya isifundazwe ekuqaleni kwesifundazwe ngokushesha ngangokunokwenzeka.
Iphoyinti 8: Ukusungulwa kwe-DRG / DIP Syneneneric Meneration Mechanism
Gqugquzela amazinga okukhokha ngendlela eqinile futhi ehlelekile. Khuthaza izifundazwe ukuthi zihlole ukuthuthukiswa kwamazinga wokukhokha wezokwelapha womshuwalense wezokwelapha futhi wenze ushintsho olushukumisayo. Thuthukisa inqubo ye-Synergistic phakathi kwamazinga okukhokha kanye namanani okuthenga aphakathi nendawo, futhi unqume amazinga wokukhokha wemikhiqizo ekhethiwe ekuthengeni kwe-band ephakathi ngokuya ngemithetho efanelekile. Hlola izingxoxo zokungena nezinye izindlela zokunquma ngokucophelela amazinga wokukhokha kwezinye izinto zezokwelapha eziphezulu. Okokudla kwezokwelashwa ngomsebenzi ofanayo nokusetshenziswa, izinto ezifanayo nezimpawu, ukuthambekela komtholampilo, ukuthambekela komtholampilo, nokuguqulwa kokuphathwa komshuwalense wezokwelapha, amazinga okukhokha ahlanganisiwe angakhiwa.
Synergize Ukuguqulwa Kwendlela Yokukhokha. Ukusungula indlela yokuphromotha nge-synergistic nge-DRG, HIP Indlela Yokukhokha Kwendlela nezinye izinqubomgomo zokwakha umphumela omuhle wokufaka. Cabanga ngesilinganiso sokukhokha, inqubo ejwayelekile yokukhokha kanye nenqubomgomo yokukhokha yokudla kwezokwelapha ngendlela ehlanganisiwe, futhi uthuthukise isabelomali esiphelele kanye nezinga lokukhokha ngezinhlobo zezifo / amaqembu ngesikhathi esifanele.
I-Point Nine: Lokhu kudla kugxilwe ekuqapheleni
Ngokwesaziso, indlela yokuqapha kanye nokuhlola inqubo yomshuwalense wezokwelapha kufanele isungulwe. Izifundazwe njalo ekufinyeleleni umshwalense wezempilo esifundazweni, ukukhokha imali yomshuwalense wezempilo, umthwalo weziguli, kanye nokuthengwa kwe-inthanethi, isilinganiso sokuthengwa kwezokuthenga, njll. Ukusetshenziswa kwesikhwama kanye nomthwalo weziguli wokudla kwezokwelapha ukuqapha umthwalo osindayo.
Ukunakekelwa kweHongguan ngempilo yakho.
Bona umkhiqizo owengeziwe weHongguan Meidlcal Clogentables →https://www.hgcmedical.com/products/
Uma kukhona izidingo ze-Medical Cumables, sicela ukhululeke ukuxhumana nathi.
hongguanmedical@outlook.com
Isikhathi sePosi: Sep-11-2023