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赞,个体诊所也能申请医保定点了!

2016-12-31 徐毓才 医学界

在2016年最后一个工作日,深圳医改又传来大好消息:2017年2月1日起,深圳所有的合法医疗机构以及此前已经被深圳医保定点的深圳域外医疗机构都有资格申请深圳医保定点了,包括诊所!一直以来,国家三令五申提出要将社会办医机构纳入医疗保险定点,享受与公立医疗机构同等的待遇。去年,国务院办公厅发布的《关于进一步加强乡村医生队伍建设的实施意见》要求,各地要将符合条件的村卫生室和个体诊所等纳入医保定点医疗机构

在2016年最后一个工作日,深圳医改又传来大好消息:2017年2月1日起,深圳所有的合法医疗机构以及此前已经被深圳医保定点的深圳域外医疗机构都有资格申请深圳医保定点了,包括诊所!

一直以来,国家三令五申提出要将社会办医机构纳入医疗保险定点,享受与公立医疗机构同等的待遇。去年,国务院办公厅发布的《关于进一步加强乡村医生队伍建设的实施意见》要求,各地要将符合条件的村卫生室和个体诊所等纳入医保定点医疗机构管理。不久前,国务院办公厅出台的《关于促进社会办医加快发展的若干政策措施》再一次提出,“纳入医保定点报销,不得将所有制性质作为医保定点的前提条件”。

但事实上,各地已经将民营医院、个体药店纳入了医疗保险定点机构,但对于“个体诊所”却一直“另眼相看”,对其纳入定点还是慎之又慎。一个最大的障碍还是难管。

但也正是由于个体诊所无法纳入医疗保险定点,使得最适宜于社会资本办医的“诊所”令人望而却步。因为在基本实现全民医保且大部分医疗机构都具有医疗保险定点的情况下,不能纳入医保定点便成了个体诊所的致命伤。因此,我们有理由相信,这次深圳给所有合法、规范经营的医疗机构放开医保定点,必将对医师申办诊所,推动医师自由执业,甚至对加快建立分级诊疗制度都会起到巨大的促进作用。

那么,深圳这次印发的《深圳市社会医疗保险定点医疗机构管理办法》(以下简称《办法》)有哪些特点呢?笔者认为起码有4点:

一是合法。

《办法》第四条,定点医疗机构应当具备的条件首先提出,只要是属于本市卫生计生行政部门批准设立的医疗机构或者经军队主管部门批准开展对外服务的军队医疗机构,都可以申请。显然这就包括了个体诊所在内。

二是规范。

《办法》在定点医疗机构应当具备的条件中,明确“申请定点医疗机构前一年内(开业不足一年的自开业之日起)未被卫生计生、市场监管等行政部门行政处罚”,言下之意,只要机构运行规范,一年内或开业后未受到行政处罚的,都可以申请定点机构。

三是可控。

《办法》同时提出一个条件,就是“按照医疗保险实时结算及监管要求建立医疗保险信息系统,实现医疗保险实时交易信息、药品进销存业务信息、电子病历信息、医师信息通过医疗保险信息系统接口对接;接入医疗保险信息系统的网络带宽不低于2M,并使用数据专线方式接入;配备医疗保险信息化专职管理人员;制定与医疗保险信息系统相适应的医疗保险信息系统故障和事故管理规范。”而这4点都是保障监管机构能够实现实时监控。显然这也是原来诊所难以监管,不予定点的根本原因。

四是动态。

为了确保定点机构的动态管理,深圳不但放开的准入,而且也对定点机构建立一套灵活的动态监管办法,谁一旦违规,即刻就可能被踢出去,而且一旦踢出去,要再进入就比较难,这也是一种激励讲诚信、讲规矩的很值得提倡的治理机制。比如《办法》第六条规定,有下列情形之一的,不得确定为定点医疗机构:

(一)以弄虚作假等不正当手段申请定点医疗机构,自发现违规行为之日起未满3年的;

(二)原定点医疗机构因违反医疗保险规定而被取消定点,自解除服务协议之日起未满3年的;

(三)原定点医疗机构停业或者关闭后未按规定向经办机构报告,自发现违规行为之日起未满3年的。

除此而外,深圳此次新政,还不仅仅限于深圳辖区内的医疗机构,还包括深圳市外的深圳医保定点医疗机构。这一点见于《办法》第二十一条:市外定点医疗机构的管理参照本办法执行。国家、广东省有另行规定的,从其规定。

那为什么说现在开始,就可以申请呢?第五条规定,经卫生行政部门核准的社区健康服务机构和政府重大民生建设项目的医疗机构,应当在开业前1个月向经办机构提出申请,符合条件的可以确定为定点医疗机构。

当然,对于同一家医疗机构内独立核算的机构或者其持有独立的《医疗机构执业许可证》的分支医疗机构,按照《办法》规定,应当单独提出申请;医疗机构有多个执业地点的,各执业地点应当按医疗机构设置标准分别提供相应的证明材料。

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1747996, encodeId=45901e4799627, content=<a href='/topic/show?id=18ab33841b2' target=_blank style='color:#2F92EE;'>#医保定点#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33841, encryptionId=18ab33841b2, topicName=医保定点)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6a1836003947, createdName=Eleven23, createdTime=Mon Sep 04 04:58:00 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1976850, encodeId=a0fe19e68505d, content=<a href='/topic/show?id=2d5c21322c6' target=_blank style='color:#2F92EE;'>#个体诊所#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21322, encryptionId=2d5c21322c6, topicName=个体诊所)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=685a124, createdName=muzishouyi, createdTime=Wed Nov 29 19:58:00 CST 2017, time=2017-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=167376, encodeId=f26416e37625, content=不错,受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Mon Jan 02 07:38:18 CST 2017, time=2017-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1310968, encodeId=f99313109687b, content=<a href='/topic/show?id=39be91564e5' target=_blank style='color:#2F92EE;'>#诊所#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91564, encryptionId=39be91564e5, topicName=诊所)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c805395, createdName=ycmayy, createdTime=Mon Jan 02 01:58:00 CST 2017, time=2017-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=167315, encodeId=ec8216e31546, content=这个知道了, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=90f31612316, createdName=xiaotaiyang1, createdTime=Sun Jan 01 22:43:04 CST 2017, time=2017-01-01, status=1, ipAttribution=)]
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    2017-01-02 1e10c84am36(暂无匿称)

    不错,受益

    0

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    2017-01-02 ycmayy
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    2017-01-01 xiaotaiyang1

    这个知道了

    0

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