按病种定额付费管理新模式的探索  

Exploration for a new management model of quota payment for specific diseases

作　　者：刘惠娟[1] 薛健辉[2] 劳幼华[1] 王东来[3] 

机构地区：[1]苏州市立医院本部医保办,江苏省苏州市215002 [2]苏州市立医院信息科,江苏省苏州市215002 [3]苏州市立医院院长室,江苏省苏州市215002

出　　处：《中华医院管理杂志》2016年第2期99-102,共4页Chinese Journal of Hospital Administration

基　　金：江苏省卫生规划财务研究课题（G201422）

摘　　要：目的我院医疗保险按病种定额付费制度已实施数年，但执行效果不理想。本研究寻找一种新的模式来对病种定额付费进行管理。方法从2013年开始试行对定额病种进行医疗费用分类及其限额确定，与信息科一起开发病种费用分类的实时监控软件，形成了一套按病种定额付费管理的新模式——病种费用分类管理。结果2014年我院将此模式正式推广运用到其他定额付费的病种中，取得实效，同时获得了医疗保险同行业管理者的一致认可。结论此模式尤其对降低患者住院费用及规范医疗行为起到积极作用。Objective The policy of quota payment for specific diseases has been earned out at me hospital for several years, yet proven a failure. This paper aims at searching for a new way of management. Methods Since 2013, attempts have been made for classification of medical costs and the quota setting for specific diseases, and for development of a real-time supervision software for classification of disease-specific costs. The attempts prove a success with a new model for management of quota management for specific diseases. Results This practice has proved to be effective in 2014, and used in other likewise diseases, which has been embraced by administrators of medical insurance sector. Conclusion This model proves useful for reducing inpatient expenses and regulating medical behaviors. but also shorten the average hospitalization days, improve the satisfaction of patient. The method of management control can be expanded and imitated.

关 键 词：医疗保险 定额支付 费用分类管理 

分 类 号：R197.32[医药卫生—卫生事业管理]