医保精细化管理助力国家骨科医学中心运行探索  

Exploration of refined medical insurance management to support the operation of the National Orthopedic Medical Center

作　　者：汪蓓[1] 俞骏仁 狄建忠[2] 姜若 俞传芳[2] WANG Bei;YU Junren;DI Jianzhong;JIANG Ruo;YU Chuanfang(Beijing Jishuitan Hospital Affiliated to Capital Medical University/National Orthopedic Medical Center,Beijing,100081,PRC)

机构地区：[1]首都医学大学附属北京积水潭医院/国家骨科医学中心,北京市100081 [2]上海市第六人民医院/国家骨科医学中心,上海市200233

出　　处：《中国医院》2024年第7期50-52,共3页Chinese Hospitals

基　　金：国家重点研发计划(2022YFC2407005);上海申康医院发展中心医疗质量安全与医疗服务模式创新项目(SHDC12023609);上海市第六人民医院院级科研项目(lygl2023019)。

摘　　要：随着医保DRG支付改革的不断深入和高值医用耗材集中采购的落地,国家骨科医学中心建设单位以国家公立考核以及医保支付改革为目标,以优势学科为重要管理对象,提出了以专科病种同质化管理为基础、临床诊疗组综合服务能力评价为核心,医用耗材合理性使用为抓手,资源激励为价值导向的医保精细化管理方案。通过医保精细化管理提高国家骨科医学中心运行,形成优势学科的规模效应,为国家医学中心建设和管理提出思考和建议。With the deepening of medical insurance DRG payment reform and the implementation of centralized procurement of highvalue medical consumables,the construction unit of the National Orthopedic Medical Center aims at national public evaluation and medical insurance payment reform.It focuses on key disciplines and proposes a refined medical insurance management plan based on the homogeneous management of specialized diseases,comprehensive service capability evaluation of clinical diagnosis and treatment teams,rational use of medical consumables,and resource incentives as value-oriented.By improving the refined medical insurance management,the operation of the National Orthopedic Medical Center is enhanced,creating a scale effect of key disciplines and providing thoughts and suggestions for the construction and management of national medical centers.

关 键 词：国家骨科医学中心 医保管理 医疗质量 高质量发展 

分 类 号：R197.3[医药卫生—卫生事业管理]