临床路径对节约医保基金的影响分析  

Analysis of the Effect of Clinical Pathway on Saving Medicare Funds

作　　者：王施[1] WANG Shi(Shengjing Hospital of China Medical University ,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院医疗保险工作部,沈阳市110004

出　　处：《现代医院管理》2018年第6期51-54,共4页Modern Hospital Management

摘　　要：目的研究临床路径对节约医保基金的作用,探索医保支付制度改良新方法,同时为医院减少医保超支现象提供新方向。方法研究某大型三甲医院2013年1月1日至2015年6月30日收治的医保类别为沈阳市城镇职工基本医疗保险,单病种名称为人工晶体置换术(单侧)的患者共计345人,按临床路径治疗的为研究组,未参与临床路径治疗的为对照组。分析临床路径、人员类别、起付金、性别对结余百分比、自付百分比、药品百分比、耗材百分比、住院天数这五个指标的影响。结果实施临床路径对提高结余百分比、降低药品百分比和缩短住院天数有积极影响,但是增加了自付百分比和耗材百分比。结论临床路径在规范医生行为、节约医保资金方面有积极作用。Objective:To study the effect of clinical pathway on saving medical insurance fund,explore new methods to improve medical insurance payment system,and provide new directions for hospitals to reduce medical insurance overexpenditure.Method:The medical insurance coverage of the basic medical insurance for urban employees in Shenyang from January 1,2013 to June 30,2015 accepted by the large-scale hospitals of Class A and Grade was studied.And a total of 345 patients were treated with single disease called iol replacement(unilateral).The clinical pathway was used in the study group,and the control group was not involved in the clinical pathway.The effects of clinical pathway,personnel category,accrual,gender on balance percentage,co-pay percentage,drug percentage,consumables percentage and length of hospital stay were analyzed.Result:The implementation of clinical pathway had positive effects on increasing the percentage of balance,decreasing the percentage of drugs and shortening the length of hospital stay.However,the percentage of deductibles and consumables increased.Conclusion:Clinical pathway plays an active role in regulating doctors’behaviors and saving medical insurance funds.

关 键 词：医保付费 临床路径 白内障人工晶体置换 

分 类 号：R197[医药卫生—卫生事业管理]