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我院应对医保总额预付的管理实践 被引量:13

Management practice of the hospital for the medical insurance lump-sum prepayment
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摘要 2013年北京市二级以上医院全面推行医保总额预付管理,我院医保管理工作核心由“费用结算”转变到“费用管理”,建立了多维度、多方法、多指标和多部门的医保总额预付管理体系.在住院业务管理中,引入按疾病诊断相关组(DRGs)管理工具,实行病组管理;在门诊业务管理中,引入同级同类医院科室比较方法,实行岗位管理;引入全面预算管理理念,建立了“病源-运营-财务-绩效”四轴联动机制,优先控制药品支出;尝试开展重点患者群与药品耗材供应商的管理. 2013 witnessed the full coverage of the medical insurance lump-sum prepayment management at all hospitals above secondary level in Beijing.As a result,medical insurance management of the hospital turned its focus from“ expense settlement” to“ expense management”,with a multidimensional,multi-method,multi-sectoral and multi-index lump-sum prepayment of medical insurance management system set up.Methods and concepts introduced included diagnosis related groups (DRGs) management tools in hospitalization service management; equivalent hospital departments comparison in outpatient service for post management; the concept of total budget management concept,and the “market-operations-finance-performance” linkage mechanism for priority control of drug expenses; and focused management on key patient groups and drug/consumable suppliers.
出处 《中华医院管理杂志》 北大核心 2014年第12期910-912,共3页 Chinese Journal of Hospital Administration
关键词 医保总额预付 疾病诊断相关组(DRGs) 数学模型 Medical insurance lump-sum prepayment Diagnosis Related Groups Mathematical model
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