精细化管理在医疗保险付费制度改革中的作用  

Effect of Delicacy Management in Medicare Payment Reform

作　　者：朱静[1] 孟洁[1] 白雪娟[1] 许丽[1] 

机构地区：[1]首都医科大学附属北京朝阳医院,北京市100020

出　　处：《中国病案》2014年第11期9-11,共3页Chinese Medical Record

摘　　要：目的探讨医疗保险精细化管理对推进医疗保险付费制度改革的积极作用。方法收集、整理2012年1月至2013年12月我院就诊的北京市城镇职工医疗保险患者发生医疗费用的数据,分析医疗保险基金申报、就诊人次、次均费、药占比的变化趋势。结果 2013年北京市城镇职工医疗保险患者在我院的就诊情况:门急诊就诊人次较2012年上升12.82%,住院人次上升4.65%;门急诊基金申报增加4.52%,住院基金申报增加2.61%;门急诊次均费下降6.97%,住院次均费下降0.99%;门急诊药占比下降13.98%,住院药占比下降17.95%。结论医院的精细化管理理念,可以有效保证总额预付任务的顺利完成,合理使用医疗保险基金,为推进医疗保险付费制度改革提供了可借鉴的经验。Objective Summarize the positive effect of delicacy management to promote the reform of Medicare payment reform,gradually discover,establish and improve the medicare management system in hospital.Methods Collect the medical expenses data of Beijing medicare patients in our hospital from January 2012 to December 2013.Analyse the trends of medicare funds, attendances, average expense and drugs proportion.Results Compared with 2012,in 2013 Outpatient and emergency medicare attendances increased 12.82%, hospitalized medicare attendances increased 4.65%;outpatient and emergency medical insurance fund increased 4.52%, hospitalized medical insurance fund increased 2.61%;outpatient and emergency medicare average expense fell 6.97%,hospitalized medicare average expense fell 0.99%;outpatient and emergency medicines cost proportion fell 13.98%,hospitalized medicines cost proportion fell 17.95%.Conclusion Delicacy management can ensure the completion of the total prepaid task successfully,rational use of medical insurance fund,provide valuable experience for medicare payment reform.

关 键 词：医疗保险 总额预付制 精细化管理 医疗保险基金 

分 类 号：R197.322[医药卫生—卫生事业管理]