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山東省醫療保障標準體系的首批標準，將于10月30日起實施。5項標準中，前2項是整個醫療保障工作的基礎標準，后3項是針對醫保經辦服務制定的專門標準。

　　省醫保(bao)(bao)(bao)(bao)(bao)局黨組(zu)書(shu)記、局長張寧波介紹，《醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)第1部(bu)分：標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)體(ti)(ti)(ti)系(xi)(xi)(xi)》規(gui)(gui)定(ding)了(le)醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)體(ti)(ti)(ti)系(xi)(xi)(xi)的(de)(de)構建原則、標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)體(ti)(ti)(ti)系(xi)(xi)(xi)的(de)(de)組(zu)成及標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)體(ti)(ti)(ti)系(xi)(xi)(xi)的(de)(de)內(nei)容(rong)，是全(quan)省醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)化(hua)建設的(de)(de)規(gui)(gui)劃性(xing)(xing)、指導性(xing)(xing)文件，不僅能(neng)為山東省推進(jin)醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)化(hua)建設提供規(gui)(gui)劃依據，也將為建立全(quan)國統(tong)一(yi)的(de)(de)醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)體(ti)(ti)(ti)系(xi)(xi)(xi)提供有益(yi)探索(suo)。主要內(nei)容(rong)包括(kuo)：系(xi)(xi)(xi)統(tong)設計了(le)山東省醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)體(ti)(ti)(ti)系(xi)(xi)(xi)框架(jia)，將醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)體(ti)(ti)(ti)系(xi)(xi)(xi)劃分為基礎共性(xing)(xing)標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)子體(ti)(ti)(ti)系(xi)(xi)(xi)、公共服(fu)務標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)子體(ti)(ti)(ti)系(xi)(xi)(xi)、管理與(yu)保(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)子體(ti)(ti)(ti)系(xi)(xi)(xi)、監(jian)督(du)與(yu)評(ping)價標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)子體(ti)(ti)(ti)系(xi)(xi)(xi)4個部(bu)分，確保(bao)(bao)(bao)(bao)(bao)了(le)醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)的(de)(de)系(xi)(xi)(xi)統(tong)性(xing)(xing)和協調性(xing)(xing)。對今后一(yi)個時期將要制定(ding)的(de)(de)標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)進(jin)行了(le)統(tong)籌規(gui)(gui)劃，提出(chu)了(le)88項(xiang)地方(fang)標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)制定(ding)任(ren)務，提升了(le)醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)化(hua)工作的(de)(de)計劃性(xing)(xing)和針對性(xing)(xing)。初步確定(ding)了(le)醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)具體(ti)(ti)(ti)工作領(ling)域和事項(xiang)標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)的(de)(de)主體(ti)(ti)(ti)內(nei)容(rong)，保(bao)(bao)(bao)(bao)(bao)證了(le)醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)地方(fang)標(biao)(biao)(biao)(biao)(biao)準(zhun)(zhun)(zhun)制修訂的(de)(de)方(fang)向(xiang)性(xing)(xing)和目的(de)(de)性(xing)(xing)。

　　《醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)(zhang)第(di)2部分：術(shu)語(yu)》規定(ding)了(le)(le)(le)(le)(le)醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)(zhang)領(ling)(ling)(ling)域(yu)(yu)(yu)的(de)(de)(de)基本術(shu)語(yu)及(ji)(ji)定(ding)義(yi)，將為全(quan)(quan)(quan)(quan)省醫保(bao)(bao)(bao)(bao)(bao)(bao)信息系(xi)統(tong)的(de)(de)(de)互(hu)聯(lian)、省和各(ge)市(shi)之間數據的(de)(de)(de)交換、重點領(ling)(ling)(ling)域(yu)(yu)(yu)改(gai)革的(de)(de)(de)互(hu)動(dong)提供有(you)(you)力支(zhi)撐。主要內(nei)容包括(kuo)對(dui)全(quan)(quan)(quan)(quan)國醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)(zhang)術(shu)語(yu)進(jin)行(xing)(xing)了(le)(le)(le)(le)(le)全(quan)(quan)(quan)(quan)面(mian)(mian)梳(shu)理(li)(li)(li)。結合現有(you)(you)醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)(zhang)制度和醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)(zhang)改(gai)革有(you)(you)關情況，對(dui)全(quan)(quan)(quan)(quan)國醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)(zhang)領(ling)(ling)(ling)域(yu)(yu)(yu)涉及(ji)(ji)到的(de)(de)(de)專業術(shu)語(yu)進(jin)行(xing)(xing)了(le)(le)(le)(le)(le)全(quan)(quan)(quan)(quan)面(mian)(mian)梳(shu)理(li)(li)(li)，確保(bao)(bao)(bao)(bao)(bao)(bao)術(shu)語(yu)界定(ding)不缺項(xiang)、不失(shi)范(fan)(fan)。對(dui)全(quan)(quan)(quan)(quan)省醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)(zhang)術(shu)語(yu)進(jin)行(xing)(xing)了(le)(le)(le)(le)(le)規范(fan)(fan)統(tong)一。長期(qi)以來，山東(dong)省16市(shi)醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)(zhang)術(shu)語(yu)表(biao)述不一，特別是醫保(bao)(bao)(bao)(bao)(bao)(bao)經辦服務(wu)事(shi)項(xiang)的(de)(de)(de)名稱缺乏統(tong)一規范(fan)(fan)，群眾常常被(bei)各(ge)種事(shi)項(xiang)名稱所困擾。該標準在全(quan)(quan)(quan)(quan)省范(fan)(fan)圍內(nei)對(dui)醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)(zhang)服務(wu)組織、參保(bao)(bao)(bao)(bao)(bao)(bao)管(guan)理(li)(li)(li)、保(bao)(bao)(bao)(bao)(bao)(bao)險待遇、基金管(guan)理(li)(li)(li)等13類術(shu)語(yu)進(jin)行(xing)(xing)了(le)(le)(le)(le)(le)統(tong)一，為重點領(ling)(ling)(ling)域(yu)(yu)(yu)改(gai)革的(de)(de)(de)整(zheng)體推(tui)進(jin)奠定(ding)了(le)(le)(le)(le)(le)基礎，也徹底解決了(le)(le)(le)(le)(le)備受(shou)詬病的(de)(de)(de)“名稱之困”。對(dui)醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)(zhang)特定(ding)概念進(jin)行(xing)(xing)了(le)(le)(le)(le)(le)規范(fan)(fan)解釋(shi)。特別是對(dui)醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)(zhang)領(ling)(ling)(ling)域(yu)(yu)(yu)的(de)(de)(de)特定(ding)概念進(jin)行(xing)(xing)了(le)(le)(le)(le)(le)釋(shi)義(yi)，既有(you)(you)利于全(quan)(quan)(quan)(quan)省醫保(bao)(bao)(bao)(bao)(bao)(bao)系(xi)統(tong)學習把握(wo)，也有(you)(you)利于提升社會各(ge)界對(dui)醫療(liao)(liao)(liao)(liao)保(bao)(bao)(bao)(bao)(bao)(bao)障(zhang)(zhang)(zhang)(zhang)領(ling)(ling)(ling)域(yu)(yu)(yu)政策(ce)制度的(de)(de)(de)理(li)(li)(li)解。

　　《醫(yi)療保障(zhang)經(jing)(jing)辦(ban)(ban)服(fu)(fu)(fu)(fu)(fu)(fu)務(wu)(wu)通(tong)則》提出了(le)醫(yi)保經(jing)(jing)辦(ban)(ban)服(fu)(fu)(fu)(fu)(fu)(fu)務(wu)(wu)的(de)(de)基礎性、通(tong)用性、整體(ti)性要(yao)求，是全(quan)省醫(yi)保經(jing)(jing)辦(ban)(ban)服(fu)(fu)(fu)(fu)(fu)(fu)務(wu)(wu)的(de)(de)總體(ti)指南(nan)。主要(yao)內(nei)容包括確立了(le)證明材料最(zui)(zui)少、辦(ban)(ban)事流(liu)程最(zui)(zui)簡、辦(ban)(ban)理(li)時(shi)(shi)限最(zui)(zui)短、服(fu)(fu)(fu)(fu)(fu)(fu)務(wu)(wu)質量最(zui)(zui)優(you)(you)的(de)(de)“四(si)個(ge)最(zui)(zui)”和統(tong)(tong)(tong)(tong)一事項名稱、統(tong)(tong)(tong)(tong)一申辦(ban)(ban)材料、統(tong)(tong)(tong)(tong)一經(jing)(jing)辦(ban)(ban)方(fang)式、統(tong)(tong)(tong)(tong)一經(jing)(jing)辦(ban)(ban)流(liu)程、統(tong)(tong)(tong)(tong)一辦(ban)(ban)理(li)時(shi)(shi)限、統(tong)(tong)(tong)(tong)一服(fu)(fu)(fu)(fu)(fu)(fu)務(wu)(wu)標準的(de)(de)“六統(tong)(tong)(tong)(tong)一”總體(ti)要(yao)求，著力打造醫(yi)保經(jing)(jing)辦(ban)(ban)服(fu)(fu)(fu)(fu)(fu)(fu)務(wu)(wu)品牌(pai)。明確了(le)服(fu)(fu)(fu)(fu)(fu)(fu)務(wu)(wu)機構和服(fu)(fu)(fu)(fu)(fu)(fu)務(wu)(wu)人(ren)員、服(fu)(fu)(fu)(fu)(fu)(fu)務(wu)(wu)對象(xiang)與方(fang)式、服(fu)(fu)(fu)(fu)(fu)(fu)務(wu)(wu)內(nei)容與要(yao)求、服(fu)(fu)(fu)(fu)(fu)(fu)務(wu)(wu)監督評價與改進等7方(fang)面的(de)(de)通(tong)用要(yao)求，對醫(yi)保經(jing)(jing)辦(ban)(ban)大廳服(fu)(fu)(fu)(fu)(fu)(fu)務(wu)(wu)設施(shi)的(de)(de)配備，服(fu)(fu)(fu)(fu)(fu)(fu)務(wu)(wu)人(ren)員的(de)(de)儀容儀態(tai)、行為舉(ju)止、服(fu)(fu)(fu)(fu)(fu)(fu)務(wu)(wu)用語、工作(zuo)紀律等進行了(le)規范，為各級(ji)醫(yi)保部門優(you)(you)化(hua)經(jing)(jing)辦(ban)(ban)服(fu)(fu)(fu)(fu)(fu)(fu)務(wu)(wu)提供了(le)基準。規定了(le)首(shou)問負責制(zhi)(zhi)(zhi)、容缺受理(li)制(zhi)(zhi)(zhi)、限時(shi)(shi)辦(ban)(ban)結(jie)制(zhi)(zhi)(zhi)、導(dao)辦(ban)(ban)代辦(ban)(ban)制(zhi)(zhi)(zhi)、否定報備制(zhi)(zhi)(zhi)、AB角工作(zuo)制(zhi)(zhi)(zhi)、延時(shi)(shi)服(fu)(fu)(fu)(fu)(fu)(fu)務(wu)(wu)制(zhi)(zhi)(zhi)等服(fu)(fu)(fu)(fu)(fu)(fu)務(wu)(wu)制(zhi)(zhi)(zhi)度，為醫(yi)保經(jing)(jing)辦(ban)(ban)服(fu)(fu)(fu)(fu)(fu)(fu)務(wu)(wu)要(yao)求的(de)(de)落實提供了(le)保障(zhang)。

　　《職(zhi)工醫(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)障(zhang)(zhang)經(jing)辦(ban)(ban)服(fu)(fu)(fu)(fu)(fu)務(wu)規(gui)范(fan)》《城鄉居民醫(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)障(zhang)(zhang)經(jing)辦(ban)(ban)服(fu)(fu)(fu)(fu)(fu)務(wu)規(gui)范(fan)》是針對(dui)不(bu)同的(de)(de)(de)醫(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)障(zhang)(zhang)制度和(he)醫(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)障(zhang)(zhang)服(fu)(fu)(fu)(fu)(fu)務(wu)對(dui)象(xiang)制定的(de)(de)(de)兩項具體(ti)(ti)(ti)醫(yi)(yi)(yi)保(bao)(bao)(bao)經(jing)辦(ban)(ban)服(fu)(fu)(fu)(fu)(fu)務(wu)標(biao)準，是對(dui)醫(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)障(zhang)(zhang)經(jing)辦(ban)(ban)服(fu)(fu)(fu)(fu)(fu)務(wu)通則的(de)(de)(de)具體(ti)(ti)(ti)細化(hua)。主要(yao)(yao)內容包括對(dui)職(zhi)工和(he)居民醫(yi)(yi)(yi)保(bao)(bao)(bao)領域的(de)(de)(de)服(fu)(fu)(fu)(fu)(fu)務(wu)事項名稱、經(jing)辦(ban)(ban)方式、經(jing)辦(ban)(ban)流(liu)程、申辦(ban)(ban)材(cai)料(liao)、辦(ban)(ban)理(li)(li)時限(xian)和(he)辦(ban)(ban)理(li)(li)結果等提(ti)出明確要(yao)(yao)求(qiu)，實現了(le)全省(sheng)醫(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)障(zhang)(zhang)經(jing)辦(ban)(ban)服(fu)(fu)(fu)(fu)(fu)務(wu)的(de)(de)(de)“六(liu)統一”，全省(sheng)參(can)保(bao)(bao)(bao)群眾在(zai)全省(sheng)任(ren)何地(di)方辦(ban)(ban)理(li)(li)醫(yi)(yi)(yi)保(bao)(bao)(bao)業務(wu)將(jiang)享受到同質(zhi)化(hua)的(de)(de)(de)服(fu)(fu)(fu)(fu)(fu)務(wu)。對(dui)經(jing)辦(ban)(ban)服(fu)(fu)(fu)(fu)(fu)務(wu)流(liu)程進(jin)行(xing)了(le)再造(zao)，就(jiu)(jiu)職(zhi)工和(he)居民醫(yi)(yi)(yi)保(bao)(bao)(bao)相關的(de)(de)(de)參(can)保(bao)(bao)(bao)登(deng)記、醫(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)險關系(xi)轉移(yi)接續、參(can)保(bao)(bao)(bao)繳費信息查詢、參(can)保(bao)(bao)(bao)地(di)就(jiu)(jiu)醫(yi)(yi)(yi)、異地(di)就(jiu)(jiu)醫(yi)(yi)(yi)、生育(yu)保(bao)(bao)(bao)險等服(fu)(fu)(fu)(fu)(fu)務(wu)要(yao)(yao)求(qiu)進(jin)行(xing)了(le)細化(hua)，推動了(le)經(jing)辦(ban)(ban)服(fu)(fu)(fu)(fu)(fu)務(wu)的(de)(de)(de)優(you)化(hua)和(he)升(sheng)級，全省(sheng)醫(yi)(yi)(yi)保(bao)(bao)(bao)經(jing)辦(ban)(ban)事項的(de)(de)(de)辦(ban)(ban)事時限(xian)整(zheng)體(ti)(ti)(ti)壓縮45.5%，辦(ban)(ban)事環節整(zheng)體(ti)(ti)(ti)精簡16.4%，申辦(ban)(ban)材(cai)料(liao)整(zheng)體(ti)(ti)(ti)縮減32.3%。對(dui)參(can)保(bao)(bao)(bao)人員(yuan)、參(can)保(bao)(bao)(bao)單(dan)位、醫(yi)(yi)(yi)保(bao)(bao)(bao)經(jing)辦(ban)(ban)機構、醫(yi)(yi)(yi)療(liao)機構等不(bu)同主體(ti)(ti)(ti)在(zai)服(fu)(fu)(fu)(fu)(fu)務(wu)事項辦(ban)(ban)理(li)(li)過程中所擔任(ren)的(de)(de)(de)角色進(jin)行(xing)了(le)明確，有利于不(bu)同的(de)(de)(de)參(can)與主體(ti)(ti)(ti)全面理(li)(li)解醫(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)障(zhang)(zhang)服(fu)(fu)(fu)(fu)(fu)務(wu)，方便參(can)保(bao)(bao)(bao)人員(yuan)更(geng)好的(de)(de)(de)享受醫(yi)(yi)(yi)療(liao)保(bao)(bao)(bao)障(zhang)(zhang)待遇。