公立医院医保基金监管模式探讨  

Discussion on the Supervision Model of Medical Insurance Funds in Public Hospitals

作　　者：马良[1] 冯海欢[1] 李耘天 MA Liang;FENG Haihuan;LI Yuntian(West China Hospital of Sichuan University,Chengdu Sichuan 610041,China;不详)

机构地区：[1]四川大学华西医院,四川成都610041

出　　处：《卫生经济研究》2023年第8期78-80,共3页

基　　金：四川省科技厅重点研发项目“丙型病毒性肝炎诊疗方案综合评价及全程化‘预防-诊疗-支付’模型的建立研究”(2021YFS0145)。

摘　　要：以A医院为例,针对医院医保基金监管壁垒,介绍基于多学科会诊(MDT)的医保基金监管模式;通过完善顶层设计、加强部门联动、梳理监管漏洞、构建智能基金监管体系、基于DRG控费、建立考核体系等措施,有效提高了医院医保基金监管效率,为其他医院开展相关工作提供参考。Taking Hospital A as an example,in response to the supervision barriers of the hospital medical insurance funds,this article introduces the supervision model of medical insurance funds based on multi-disciplinary treatment.By improving top-level design,strengthening departmental linkage,sorting out supervision loopholes,building an intelligent fund supervision system,controlling cost based on DRG,and establishing an assessment system,the efficiency of hospital medical insurance fund supervision has been effectively improved.These suggestions provide reference for other hospitals to carry out related work.

关 键 词：公立医院 医保基金监管 多学科会诊 

分 类 号：R197.3[医药卫生—卫生事业管理]