总额预付背景下医院医保管理策略的调整与思考  

Adjustment and Thinking of Hospital Medical Insurance Management Strategy Under Global Budget

作　　者：崔立君[1] 孙常洁[1] 梁超[1] 赵蕊[1] 毛静馥[2] 赵璐[2] 李洋[1] 

机构地区：[1]哈尔滨医科大学附属第一医院,黑龙江哈尔滨150001 [2]哈尔滨医科大学公共卫生学院,黑龙江哈尔滨150081

出　　处：《中国医院管理》2016年第12期88-89,共2页Chinese Hospital Management

基　　金：黑龙江省社会科学研究规划年度项目(13D052)

摘　　要：目的探寻总额预付制度对于三级综合医院医保管理工作的影响,并有针对性的提出改进措施。方法采用访谈法、比较法等收集信息资料,并对相关数据进行统计处理和实施效果分析。结果医院对管理策略的合理调整,有助于多种角度控制医疗费用增长,临床医务人员在诊疗行为方面趋于规范化,不合理用药现象减少。结论总额预付制度的实施有助于医院医疗费用的控制,医保的管理意识得到强化。Objective To deeply explore the effect of global budget system on the medical insurance management strategy of tertiary comprehensive hospital, and to propose targeted improvement measures. Methods Using interview method, comparison method to collect information, and doing the related data statistics processing and effect analysis. Results Hospitals’ rational management adjustment help to control medical expense increase, make medical staff in the clinical diagnosis and treatment behavior tend to be standardized, and reduce irrational drug use. Conclusion The implementation of the global budget system can help to control the hospital medical expense, and to strengthen the medical insurance management awareness.

关 键 词：总额预付制度 管理策略 医疗保险 

分 类 号：R197.32[医药卫生—卫生事业管理]