医院医保医疗费用规范管理对医保支付效果的影响  

Influence of Hospital Medical Insurance Expense Management on Medical Insurance Payment Effect

作　　者：谭卉妍[1] 邹志辉[2] 陈敏[1] 黄凡 赖永洪[2] 

机构地区：[1]广州医科大学附属第一医院,广州510120 [2]广州医科大学附属第三医院,广州510150

出　　处：《中国医疗保险》2018年第2期56-59,共4页China Health Insurance

摘　　要：目的:探讨医院医保医疗费用规范化管理对医保支付效果的影响。方法 :对广州地区17家三级综合公立医院执行《全国医院医疗保险服务规范》情况进行调查评价,并分析各医院同期医保住院费用的支付效果指数。结果 :各医院医保规范化管理评价得分、医院医疗费用管理评价得分与该医院的医保支付效果指数均呈显著正相关关系;医疗费用管理较好组、欠佳组医院的医保支付效果指数差异明显;支付效果较好医院的医疗费用管理评价得分也明显高于支付效果不好的医院。结论:医院医保服务规范化管理与医疗费用管理做得越好,其支付效果越理想;医疗费用管理较好医院的医保支付效果明显优于费用管理欠佳的医院。Objective To explore the hospital medical insurance expenses standardized management of the impact on the payment efi ect. Methods： Through evaluating the implementation of the 〈National Hospital Medical Insurance Service Standard〉 and analyzing the payment efi ect of medical insurance in 17 AAA comprehensive public hospitals in Guangzhou. Results： The evaluation score of the standardized management evaluation of the hospital was positively correlated with the insurance effect index of the hospital and the effect index between hospital medical insurance fee and payment. That efi ect index difi erence was obviously between difi erent medical insurance expense management group. The hospital＇s medical insurance expense management evaluation score is also obviously higher than the hospital with poor payment efi ect. Conclusion： If the managements of hospital medical insurance services standardsand medical insurance management is better, the payment efi ect will be more ideal. The medical insurance payment efi ect of the hospital with good medical insurance expense management is obviously superior to the hospital with poor management.

关 键 词：医院医保管理 医疗费用管理 医保支付效果 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]