基于“浮动费率”法的公立医院医保管理探索与实践  

Exploration and Practice of Public Hospital Healthcare Insurance Management Based on “Floating Rate” Method

作　　者：殷晓露 王华静[1] 余臻峥[1] 梅磊[1] 陈婷 马永刚[1] YIN Xiao-lu;WANG Hua-jing;YU Zhen-zheng(Renmin Hospital of Wuhan University,Wuhan,430060,China;不详)

机构地区：[1]武汉大学人民医院,武汉430060

出　　处：《中国卫生经济》2022年第2期74-76,共3页Chinese Health Economics

摘　　要：按DRG付费结算能够科学高效地使用医保基金,是医保支付方式改革的重要方向。为突破DRG预付制的局限性,提高DRG付费与临床实际工作的契合度,加快DRG支付政策在医疗机构有效落地,样本医院在院内结算中实施“浮动费率”策略,鼓励临床科室以预设的支付标准作为参考,在控制平均住院日、药耗费用和杜绝违规收费的基础上,按照临床实际需要为患者提供医疗服务。“浮动费率”的开展,兼顾了医疗质量与DRG高效使用医保基金的优势,并且显著提高了患者和医务人员的满意度。DRG Payment is one of the important and promising ways to scientifically and efficiently use the medical insurance funds,so as to break through the limitations of DRG prepayment system,improve the fit between DRG payment and clinical practice,and speed up the effective implementation of DRG payment policy in medical institutions.The sample hospitals have implemented a "variable rate" strategy in their in-hospital billing,encouraging clinical departments to use the pre-determined payment rates as a reference to provide care to patients according to clinical needs,while controlling the average length of stay,drug costs and eliminating irregular charges.The implementation of the “variable rate” strategy has balanced quality of care with the advantages of efficient use of health insurance funds by traditional DRG,and has significantly improved patient and staff satisfaction.

关 键 词：按疾病诊断相关分组 支付方式 浮动费率 医疗质量 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] F2[经济管理—国民经济]