Sosyal G\u00fcvenlik Kurumu (SGK), \u201cRisk Odakl\u0131 Denetim Modeli\u201dni kullanarak, \u201criskli\u201d oldu\u011funu tespit etti\u011fi bin 322 \u00f6zel sa\u011fl\u0131k hizmet sunucusu ile 2 bin 364 eczaneyi denetime ald\u0131. Denetim sonucu, 2. ve 3. basamak yo\u011fun bak\u0131m yata\u011f\u0131 olmad\u0131\u011f\u0131 halde 94 \u00f6zel hastanenin 2. ve 3. basamak yo\u011fun bak\u0131m i\u015flem bedellerine ait toplam 4 milyon 72 bin 232 liray\u0131 kuruma fatura etti\u011fi belirlendi.<\/strong><\/p>\n 30 Ekim 2012, H\u00fcrriyet<\/p>\n Risk Odakl\u0131 Denetim Modeli kapsam\u0131nda, kurum ile s\u00f6zle\u015fmesi olan \u00f6zel hastaneler ve eczaneler i\u00e7in sigortal\u0131lar\u0131n doktora m\u00fcracaat\u0131ndan re\u00e7etelerin teslim edildi\u011fi ana kadar hizmet ak\u0131\u015f s\u00fcre\u00e7leri olu\u015fturuldu. Bu s\u00fcre\u00e7lerde ortaya \u00e7\u0131kabilecek olas\u0131 riskler dikkate al\u0131narak, \u00f6l\u00e7\u00fclebilen risk fakt\u00f6rleri belirlendi.<\/p>\n S\u00f6z konusu denetim sistemiyle, veriye dayal\u0131, \u015feffaf etkin ve yerinde bir denetim sistemimin temelleri at\u0131ld\u0131. B\u00f6ylece SGK ile s\u00f6zle\u015fmesi olan \u00f6zel sa\u011fl\u0131k hizmet sunucular\u0131 ile eczanelere y\u00f6nelik yap\u0131lan denetimler daha etkili hale geldi.<\/p>\n En \u00e7ok re\u00e7ete yazan ilk 100 doktor SGK’n\u0131n takibinde<\/strong><\/p>\n \u00c7al\u0131\u015fma kapsam\u0131nda, hastaneler ile eczanelerin risklili\u011fini tespit etmek amac\u0131yla baz\u0131 parametreler belirlendi. Buna g\u00f6re, re\u00e7ete say\u0131s\u0131 ve re\u00e7ete tutarlar\u0131 bak\u0131m\u0131ndan en \u00e7ok re\u00e7ete yazan ilk 100 doktor ve bu doktorlar\u0131n en \u00e7ok yazd\u0131\u011f\u0131 ilk 10 ila\u00e7, bu re\u00e7etelerinin gitti\u011fi ilk 10 eczane, tutar ve kutu adedi bak\u0131m\u0131ndan en \u00e7ok re\u00e7ete edilen ilk 50 ila\u00e7 ve bu ila\u00e7lar\u0131 en \u00e7ok yazan ilk 10 doktor takibe al\u0131nd\u0131.<\/p>\n Hasta say\u0131s\u0131nda normal olmayan art\u0131\u015flar<\/strong><\/p>\n Risk Odakl\u0131 Denetim Modeli kapsam\u0131nda, hastaneler i\u00e7in de \u015fu parametreler belirlendi:<\/p>\n \u201c-Sa\u011fl\u0131k hizmeti alan genel sa\u011fl\u0131k sigortal\u0131s\u0131 ve bakmakla y\u00fck\u00fcml\u00fc oldu\u011fu ki\u015filer veya \u00fc\u00e7\u00fcnc\u00fc \u015fah\u0131slar\u0131n usul\u00fcne uygun ihbar ve \u015fikayetleri.<\/p>\n -Hasta say\u0131s\u0131, ortalama maliyet ve toplam fatura tutarlar\u0131nda aylar itibar\u0131yla normal olmayan art\u0131\u015flar\u0131n tespit edilmesi.<\/p>\n -Acil poliklinik hasta say\u0131s\u0131nda fazlal\u0131k veya art\u0131\u015f tespit edilmesi.<\/p>\n -Acil ve di\u011fer polikliniklerde ayn\u0131 g\u00fcn kayd\u0131 olan hastalarda art\u0131\u015f tespit edilmesi.<\/p>\n -Bran\u015f d\u0131\u015f\u0131 muayene ve tetkik i\u015flemlerinde fazlal\u0131k tespit edilmesi.\u201d<\/p>\n 6 hastanenin acil oran\u0131 y\u00fczde 90’\u0131n \u00fczerinde<\/strong><\/p>\n SGK, Risk Odakl\u0131 Denetim Modeli kapsam\u0131nda, bin 322 \u00f6zel sa\u011fl\u0131k hizmet sunucusu ile 2 bin 364 eczanenin riskli oldu\u011fu ve denetlenmesi gerekti\u011fi kanaatine vard\u0131. Buna g\u00f6re, acil m\u00fcracaat ile ilgili 250, BT (bilgisayarl\u0131 tomografi) ve MR (manyetik rezonans g\u00f6r\u00fcnt\u00fcleme) ile ilgili 279, diyaliz ile ilgili 268, yo\u011fun bak\u0131m ile ilgili 110 ve bunlar\u0131n d\u0131\u015f\u0131ndaki baz\u0131 i\u015flemlerle ilgili de 415 \u00f6zel sa\u011fl\u0131k hizmet sunucusu denetim kapsam\u0131na al\u0131nd\u0131.<\/p>\n Eczane-doktor aras\u0131nda ili\u015fki ile ilgili bin 715, majistral (re\u00e7eteye yaz\u0131lm\u0131\u015f form\u00fcle g\u00f6re eczac\u0131lar taraf\u0131ndan haz\u0131rlanan) ila\u00e7lar ile ilgili 26, eczane-ila\u00e7 ve di\u011fer ili\u015fkilerle ilgili 623 eczane riskli bulunarak, Rehberlik ve Tefti\u015f Ba\u015fkanl\u0131\u011f\u0131na bildirildi.<\/p>\n Uygulamalar sayesinde suistimallerin \u00f6n\u00fcne ge\u00e7meyi ama\u00e7layan SGK, \u00e7al\u0131\u015fmalar kapsam\u0131nda, g\u00fcnl\u00fck ortalama 60 ila 300 aras\u0131nda re\u00e7ete yazan 861 hekim bulundu\u011funu, \u00f6zel sa\u011fl\u0131k tesislerinden 6’s\u0131n\u0131n y\u00fczde 90’\u0131n \u00fczerinde acil oran\u0131na sahip oldu\u011funu tespit etti. Ayr\u0131ca 2. ve 3. basamak yo\u011fun bak\u0131m yata\u011f\u0131 olmad\u0131\u011f\u0131 halde 94 \u00f6zel hastanenin 2. ve 3. basamak yo\u011fun bak\u0131m i\u015flem bedellerine ait toplam 4 milyon 72 bin 232 liray\u0131 kuruma fatura etti\u011fi belirlendi<\/p>\n<\/p>\n \u00a0<\/p>\n http:\/\/www.hurriyet.com.tr\/gundem\/21810922.asp<\/p>\n","protected":false},"excerpt":{"rendered":" Sosyal G\u00fcvenlik Kurumu (SGK), \u201cRisk Odakl\u0131 Denetim Modeli\u201dni kullanarak, \u201criskli\u201d oldu\u011funu tespit etti\u011fi bin 322 \u00f6zel sa\u011fl\u0131k hizmet sunucusu ile...<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[63],"tags":[],"class_list":["post-3209","post","type-post","status-publish","format-standard","hentry","category-basinda-saglik"],"aioseo_notices":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=\/wp\/v2\/posts\/3209","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3209"}],"version-history":[{"count":0,"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=\/wp\/v2\/posts\/3209\/revisions"}],"wp:attachment":[{"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3209"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3209"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.ced.org.tr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3209"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}