长期护理保险居家护理服务质量监管平台的建设构想  

Concept of Constructing a Quality Supervision Platform for Home Care Plans of Long-Term Care Insurance

作　　者：俞玲娜[1] 汤莉[1] 谭鸿霞 吴丽[1] 赖永洪 刘敏涓 潘晓雷 

机构地区：[1]广东省第二人民医院,广州510317 [2]广东省医院协会医院医保管理专业委员会,广州510110 [3]广东省医院协会,广州510110

出　　处：《中国医疗保险》2024年第11期76-81,共6页China Health Insurance

基　　金：广东省第二人民医院护理提质创新项目“互联网+护理服务平台在老年用户中的体验测评研究”(YH2023-1);广州市科技计划项目“网络疑病症严重程度量表的汉化修订及在慢性病患者的应用研究”(2003A03J0285)。

摘　　要：目的:系统梳理国内失能老人对长期护理保险(以下简称“长护险”)中居家护理服务效果的需求进展,为优化我国长护险质量监管效能提供建议。方法:采用文献综述、逻辑分析等方式,深入剖析当前我国长护险效应评价的核心问题和现实基础,并提出长护险居家护理服务质量监管平台的构想。结果:以广州市长护险相关政策为参照、以参保对象需求为导向、以护理程序为基础设计的质量监管系统平台,可提高服务对象护理计划的准确性,并落实居家护理的全程监管,从而实现对参保对象居家护理评估-决策-实施-评价全程的管理闭环。结论:建立基于当前居家护理项目的计划决策、质量评价知识库,以实现与医保经办、定点机构、医疗机构的专科护理和管理延续,可简化参保对象的办理流程,并为长护险的精准保障和支付,以及与“互联网+护理服务”融合发展提供新的思路。Objective:The paper systematically reviews the progress of the demand for home care service of long-term care insurance of the disabled elderly in China,to provide policy suggestions for optimizing the quality supervision efficiency of long-term care insurance in China.Methods:Through literature review,logical analysis and other research methods,the paper deeply analyzes the core issues and practical basis of the evaluation of the effectiveness of long-term care insurance in China,and proposes the concept of a quality supervision platform for long-term care insurance home care service.Results:The quality supervision platform with the relevant policies of long-term care insurance in Guangzhou as a reference,guided by the needs of insured individuals,and based on nursing procedures can improve the accuracy of nursing plans for service recipients and implement full process supervision of home care,thereby achieving a closed-loop management of home care evaluation,decision-making,implementation,and evaluation for the insured.Conclusion:The establishment of a knowledge base for planning,decision-making and quality evaluation based on the current home care project to achieve the continuity of specialist care and management with medical insurance operators,designated institutions and medical institutions can simplify the process of long-term care insurance for the insured and provide new ideas for the accurate guarantee and payment,as well as for the integration and development of long-term care insurance with the“Internet plus nursing service”.

关 键 词：长期护理保险 居家护理 信息平台 质量监控 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]