医保基金监管大背景下医保控费精细化管理研究——基于江苏某省属儿童专科医院的实践分析  

Research on refined management of healthcare cost control under the background of supervision of the healthcare security funds—based on the practical analysis of a provincial children s hospital in Jiangsu

作　　者：左晓燕 罗毅[1] 朱洁[1] 何剑[1] 朱文龙 邵敏 张旭 ZUO Xiaoyan;LUO Yi;ZHU Jie;HE Jian;ZHU Wenlong;SHAO Min;ZHANG Xu(Medical Insurance Office,Children s Hospital of Soochow University,Suzhou Jiangsu 215108,China)

机构地区：[1]苏州大学附属儿童医院医保办,江苏苏州215108

出　　处：《卫生软科学》2023年第9期75-78,共4页Soft Science of Health

基　　金：江苏省妇幼保健科研项目课题:DRG支付背景下苏州市儿童专科医院服务项目调整及效应研究(F202224)。

摘　　要：回顾在医保部门常态化基金监管的新形势下,江苏某省属儿童专科医院利用信息化手段对医生工作站、护士工作站等各类子系统进行事前-事中-事后的全流程监控,创建具有儿童特色的医保基金控费模式的实践经验,总结多举措在提高医保工作效率、规范医务人员合理合规收费,控制不合理医疗费用等方面的成效,对有效推进医院医保管理工作的智能化和专业化,提升医疗机构自身医保控费精细化管理水平进行有益探索。Under the new situation of normalized fund supervision of the medical insurance department,a provincial children s hospital in Jiangsu uses information technology to monitor the whole process of various subsystems such as doctor workstations and nurse workstations before,during and after the process,to create the practical experience of the mode of healthcare cost control with children s characteristics.Various measures in improving the work efficiency of healthcare security,standardizing reasonable and compliant charges of medical staff,and controlling unreasonable medical expenses are summarized.It is a beneficial exploration for effectively promoting the intelligence and specialization of medical insurance management in hospitals and improving the refined management level of medical institutions healthcare cost control.

关 键 词：精细化 基金监管 控费 

分 类 号：R194[医药卫生—卫生事业管理]