总额预付制下公立医院医保费用控制策略  

Medical Insurance Costs Control Strategies under the Total Budget Payment System in Public Hospitals

作　　者：姚胜男 王筱慧[1] 乔丽名[1] 项耀钧[1] 

机构地区：[1]第二军医大学长海医院,上海200433

出　　处：《解放军医院管理杂志》2014年第5期451-452,484,共3页Hospital Administration Journal of Chinese People's Liberation Army

摘　　要：总额预付制的实施,使公立医院面临着医疗保险费用指标的压力,在政策导向下,医院必须在总额预算内精打细算。本文从医院角度出发,总结一系列医保费用控制策略,分析各方法的利弊,进而提出医保预付体制下医院应坚持以公益性质为核心、转变医院管理模式,依托信息化手段、实现过程控制,推进临床路径管理、实现单病种费用控制,从而形成医保费用控制常态长效机制。With the implementation of total budget payment system , public hospitals have to face the pres-sure of total health budget .So they have to be carefully reckoning the total budget .The article discussed a series of medical cost control strategy on the basis of analyzing the advantages and disadvantages of each method from the perspective of hospitals .Then it put forward that hospitals should change the management mode by regarding the public welfare as the core , and realize the process control relying on perfect information systems , and use the single-disease quality management to control heath care costs by promoting the clinical pathway .

关 键 词：总额预付 公立医院 医疗保险 费用控制 临床路径 单病种 

分 类 号：R197.32[医药卫生—卫生事业管理]