公立医院在规范医保基金使用中的若干思考  

Refl ections on Public Hospitals Standardizing the Use of Healthcare Security Funds

作　　者：刘静[1] 田兔红[1] 黄秀芹[1] 姚晨 

机构地区：[1]泰州市人民医院,泰州225300

出　　处：《中国医疗保险》2022年第5期71-74,共4页China Health Insurance

基　　金：江苏省医院协会医院管理创新研究课题“DRG点数法付费改革对医院运营效率的影响研究”(JSYGY-3-2021-59);江苏省医院协会“加强公立医院绩效考核工作”专项研究课题“DRG点数法付费改革实施效果实证研究”(JSYGY-2-2021-PJ96)。

摘　　要：医保基金监管工作是一项长期性的任务,医保基金的安全、合理使用,不仅关系到国家政策、群众利益,更关系到公立医院的良好信誉及公益形象。鉴于此,泰州市某三甲医院对如何有效监管医保基金使用规范性进行了一系列的探索和思考。本文从当前医院医保及价格管理角度出发,剖析医保基金使用常见违规问题及原因,介绍泰州市某三甲医院的改进策略,最后利用统计学方法对实施改进策略后的效果进行评价,为公立医院的基金监管工作提供参考。The supervision of healthcare security fund is a long-term task,whose safety and rational use is not only related to national policies and the interests of the people,but also related to the good reputation and public image of public hospitals.In view of this,one fi rst-grade hospital in Taizhou has carried out a series of exploration on how to eff ectively supervise the use of healthcare security.From the perspective of current hospital medical insurance and price management,this paper analyzes the common illegal problems and reasons in the use of healthcare security fund,and implements the improvement strategy.Finally,the statistical method is used to evaluate the eff ect of the implementation of the improvement strategy,so as to provide reference for the fund supervision of public hospitals.

关 键 词：医保基金 举措 建议 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]