DRG支付方式下的医院医保沟通机制和流程管理研究  

Research on hospital medical insurance communication mechanism and process management under DRG payment method

作　　者：苏丽华 杨翼帆 胡亚楠 段剑飞 刘瑞普 金亚娜 王淑慧 SU Lihua;YANG Yifan;HU Yanan;DUAN Jianfei;LIU Ruipu;JIN Yana;WANG Shuhui(Hematology Hospital of Chinese Academy of Medical Sciences(Institute of Hematology,Chinese Academy of Medical Sciences),State Key Laboratory of Experimental Hematology,National Clinical Research Center for Hematological Diseases,Tianjin,300020 China)

机构地区：[1]中国医学科学院血液病医院(中国医学科学院血液学研究所),实验血液学国家重点实验室,国家血液系统疾病临床医学研究中心,天津300020

出　　处：《中国卫生产业》2021年第19期73-77,共5页China Health Industry

基　　金：中国医学科学院血液病医院(中国医学科学院血液学研究所)第二批管理课题(GL1903);天津市医院协会医院管理研究项目(2019ZZ01)。

摘　　要：该文结合某公立医院推行DRG支付方式改革的主要做法,分析医院医保部门在DRG改革的管理效果和作用,探讨DRG支付模式下的医保内外沟通机制和流程管理模式。根据DRG模拟运行现状和发现的问题,提出下一步应对策略,确保DRG在医院正常运行,提高医院医保精细化管理水平,为DRG支付方式在公立医院的实施提供实践经验。This article combines the main methods of a public hospital to implement the DRG payment reform,analyzes the management effect and role of the hospital medical insurance department in the DRG reform,and discusses the internal and external communication mechanism and process management mode of medical insurance under the DRG payment model.According to the current situation of DRG simulation operation and the problems found,the next response strategy is proposed to ensure the normal operation of DRG in hospitals,improve the level of refined management of hospital medical insurance,and provide practical experience for the implementation of DRG payment methods in public hospitals.

关 键 词：按疾病诊断相关分组 医保管理 沟通协调机制 全流程管理模式 

分 类 号：R19[医药卫生—卫生事业管理]