医保基金高压监管态势下公立医院应对策略研究  

Research on the coping strategies of public hospitals under the high-pressure supervision of medical insurance funds

作　　者：李妍[1] Li Yan(Haihe Hospital,Tianjin 300350,China)

机构地区：[1]天津市海河医院,天津300350

出　　处：《首都食品与医药》2025年第9期8-10,共3页Capital Food Medicine

摘　　要：随着医保基金监管力度不断加强,公立医院承受着空前压力,医保基金使用的合规性与合理性必须高度重视,每一项诊疗行为、每一笔费用支出都需仔细审核与精确测算。本文深入剖析医保基金高压监管的背景、现状及对公立医院的影响,从完善内部管理体系、加强信息化建设、提升医疗服务质量与效率、强化医保政策宣传与培训以及积极探索创新支付方式下的管理模式等方面提出公立医院的应对策略,旨在助力公立医院在医保基金高压监管环境下实现合规运营、可持续发展,保障医保基金安全、合理、合规地使用,为患者提供优质且高效的医疗服务。With the continuous strengthening of the supervision of medical insurance funds,public hospitals are under unprecedented pressure.The compliance and rationality of the use of medical insurance funds must be highly valued,and every medical treatment behavior and every expense must be carefully reviewed and accurately calculated.This article deeply analyzes the background,current situation and impact of the high-pressure supervision of medical insurance funds on public hospitals,and proposes coping strategies for public hospitals from aspects such as improving the internal management system,strengthening information construction,enhancing the quality and efficiency of medical services,strengthening the publicity and training of medical insurance policies,and actively exploring the management model under innovative payment methods.The aim is to help public hospitals achieve compliant operation and sustainable development in the high-pressure supervision environment of medical insurance funds,ensure the safe,reasonable and compliant use of medical insurance funds,and provide high-quality and efficient medical services to patients.

关 键 词：医保基金 高压监管 公立医院 应对策略 

分 类 号：R197.32[医药卫生—卫生事业管理]