按病种分值付费下医院医保控费管理实践分析  

Practice and Analysis of Hospital Medical Insurance Cost Control Management under the Condition of Payment by Disease Points

作　　者：郑丹桂[1] 孙俊如[1] 王宇 蔡月桃[1] ZHENG Dan-gui;SUN Jun-ru;WANG-Yu;CAI Yue-tao(Medical Insurance Office,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院医疗保险办公室,广州市510630

出　　处：《现代医院管理》2021年第3期45-48,共4页Modern Hospital Management

摘　　要：按病种分值付费政策的实施,对医院控费管理提出了变革性要求。医院作为医保政策落地的实践者,其在医保控费管理所做的探索与成效,直接反映了医保支付方式改革效果。本文以广州市某大型三甲综合医院为研究对象,通过深入剖析按病种分值付费支付方式对医院带来的各方面影响,呈现全流程的医保智能控费管理模式的构建过程,进一步分析按病种分值付费政策对医院控费管理实施效果的影响,提出了支付方式改革下控费管理的进一步探索与共建方向。The implementation of the policy of payment by points of different diseases has put forward transformative requirements for hospital cost control management.Hospitals,as the practitioners of medical insurance policy,have explored and achieved results in medical insurance cost control management,which directly reflects the effect of medical insurance payment reform.Exampled by a large comprehensive hospital of class a and grade three in Guangzhou as the research object,and through in-depth analysis of the influence of payment based on points of disease on all aspects of the hospital,this paper presents the whole construction process of intelligent cost control management of medical insurance,further analyzes the impact of the pay-per-disease policy on the implementation effect of hospital cost control management,puts forward the exploration and joint construction direction of cost control management under the reform of payment mode in the future.

关 键 词：按病种分值付费 医保控费管理 支付方式 改革 

分 类 号：R197[医药卫生—卫生事业管理]