医院病案编码员道德风险的行为方式分析及防范  

Behavior Pattern Analysis and Precautions of Moral Hazard of Hospital Medical Record Coders

作　　者：王国林[1] 曹冬梅[1] 陶源[1] WANG Guo-lin;CAO Dongmei;TAO Yuan(Medical Record Statistics Department,Changzhou First People's Hospital,Changzhou 213003,China)

机构地区：[1]常州市第一人民医院病案统计室,江苏常州213003

出　　处：《医学与哲学》2023年第8期34-38,共5页Medicine and Philosophy

摘　　要：从编码员操纵分组路径、锚定固定结付率和不合理的辅助建议三个方面论述了编码员道德风险的行为方式和表达结果,讨论了编码员道德风险负性结果的外溢和内溢,以及道德风险的行为传导,并从医保基金补偿驱动、医疗服务考核压力、负性后果预见性不够和分组方案内在不足等方面剖析了编码员道德风险的产生原因,进而从加强宣传教育、把握编码微观过程、构建合理的监管体系和完善分组方案等方面为编码员规避道德风险行为提出相应对策。This paper discusses coders'behavior and result expression of moral hazard from three aspects:coders'manipulation of grouping path,anchoring of fixed settlement rate and unreasonable auxiliary suggestions.The external spillover and internal spillover of negative moral hazard results and the behavioral transmission of moral hazard are discussed.It also analyzes the causes of moral hazard of coders from the aspects of compensation drive of medical insurance fund,pressure of medical service assessment,lack of predictability of negative consequences and inherent deficiency of grouping scheme.Then the corresponding countermeasures are put forward for coders to avoid moral hazard behavior from the aspects of strengthening publicity and education,grasping the micro-process of coding,constructing supervision system and perfecting grouping scheme.

关 键 词：疾病诊断相关分组 编码员 道德风险 

分 类 号：R-05[医药卫生]