“行政MDT”在医院医保管理中的探索与运用  

Exploration and Application of Administrative MDT in Hospital Medical Insurance Management

作　　者：李长江[1] 林宁[2] 肖瑾[3] 万艳春[4] 王君华[5] Li Changjiang;Lin Ning;Xiao Jin;Wan Yanchun;Wang Junhua(Medical Insurance Office,Huai’an First People’s Hospital Branch,Huaian 223002,China;Huai’an First People’s Hospital,Huaian 223002,China)

机构地区：[1]淮安市第一人民医院分院医保科,江苏淮安223002 [2]淮安市第一人民医院院部,江苏淮安223002 [3]淮安市第一人民医院分院护理部,江苏淮安223002 [4]淮安市第一人民医院分院感管科,江苏淮安223002 [5]淮安市第一人民医院分院院部,江苏淮安223002

出　　处：《江苏卫生事业管理》2019年第5期622-625,共4页Jiangsu Health System Management

基　　金：江苏省医院协会医院管理创新研究基金面上指导课题(JSYGY-3-2018-185)

摘　　要：目的:探讨"行政MDT"管理模式在医院医保管理工作中的运用及效果。方法:比较实施医保"行政MDT"管理模式前(2016年度)与实施医保"行政MDT"管理模式后(2017年度)不同质控指标。结果:实施医保"行政MDT"管理模式后,医保患者平均出院时间、次均住院费用、平均住院日和住院药占比均降低,住院患者满意度提高,差异均有统计学意义。结论:实施医保"行政MDT"管理模式可以实现医保患者多科室联动管理,合理控制医保质控指标,节约医疗资源,控制医保基金不合理支出,提升医院管理水平。Objective:To investigate the application and effect of Administrative MDT management mode in hospital medical-insurance management.Methods:The quality control indexes were compared between 2016(not carrying out administrative MDT in hospital medical-insurance management)and 2017(carrying out administrative MDT).Results:After the implementation of administrative MDT,the average discharge time,the average hospitalization cost,the average hospitalization day and the proportion of hospitalized drugs of medical insurance patients were significantly decreased(t=75.85,7.319,9.277,19.373,P<0.01),and the satisfaction rate of hospitalized patients was significantly increased(t=8.496,P<0.01).Conclusions:The implementation of the“administrative MDT”management mode in hospital medical-insurance management can realize the coordinated management of multiple departments,reasonably control the quality control indexes of medical-insurance,save medical resources,control the unreasonable expenditure of medical-insurance funds,and improve the level of hospital management.

关 键 词：行政MDT 医保管理 质控指标 患者满意度 

分 类 号：R197.1[医药卫生—卫生事业管理]