新形势下生育保险费用精细化管理探索与实践——基于某三级综合性医疗机构视角  

Exploration and practice of refined management of maternity insurance expenses in the new situation——Based on the perspective of a three⁃level comprehensive medical institution

作　　者：周怡彤 万彬 丁海霞 ZHOU Yitong;WAN Bin;DING Haixia(Medical Insurance Department,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院医疗保险处,江苏南京210029

出　　处：《南京医科大学学报（社会科学版）》2020年第6期584-588,共5页Journal of Nanjing Medical University（Social Sciences）

基　　金：江苏省医院协会医院管理创新研究重大、重点课题“DRGs支付方式对医院管理的影响研究”(JSYGY-1/2-2019-229)。

摘　　要：城市公立医院医疗服务价格改革后,部分医疗服务收费价格提高,生育医疗费用上升,加之“二孩”政策全面实施,生育保险基金支出大幅增加,当期结余率下滑,基金运行压力剧增,医疗机构生育保险费用管理压力随之增大。在新形势下,将有限的生育保险基金做到最大化、最优化利用,实现生育保险费用的精细化管理,对医疗机构整体运行发展具有重要意义。文章基于某三级综合性医疗机构视角,简述在职工医保与生育保险合并的趋势下,医院医保管理部门对生育保险精细化管理的探索与实践,为医院医保管理部门提升生育保险费用精细化管理水平提出建议。After the reform of medical service prices in urban public hospitals,the charging price of some medical services increased,and the expenses for maternity medical care increased,and the two⁃child policy was fully implemented.The pressure on expense management had increased.Under the new situation,maximizing and optimizing the use of limited maternity insurance funds and realizing the precise management of maternity insurance costs were of great significance to the overall operation and development of medical institutions.Based on the perspective of a three⁃level comprehensive medical institution,this article briefly described the exploration and practice of the fine management of maternity insurance by the hospital medical insurance management department under the trend of the merger of employee medical insurance and maternity insurance,which put forward suggestions for the hospital medical insurance management department to improve the fine management level of maternity insurance expenses.

关 键 词：生育保险 精细化管理 探索实践 

分 类 号：R197.1[医药卫生—卫生事业管理]