摘要
目的对公立医院医保住院费用管理工作进行切实的调查,就工作中出现的问题提出解决对策和方案,研究以流程管理为中心的医保费用管理效果。方法从珠江两岸100家公立医院中随机选取2013年7月到2014年7月医保住院患者各40人,根据是否实施流程管理进行分组,实施流程化管理2200例和非流程化管理1800例,分别调查两组患者的住院费用、满意度及各环节衔接率。结果无流程化管理的医院45家,费用包括住院费、诊断费、手术费、药品费、检查费等,平均每家医院为280.9±103.4万,患者满意度为74.83%,诊疗流程中各环节衔接率为24.44%;有流程化管理的有55家,费用平均为180.7±68.2万,患者满意度为90.91%,诊疗流程中各环节衔接率为69.09%。流程化管理组的医保费用、患者满意度、衔接率与无流程化管理组对比具有统计学差异(P<0.05)。结论以流程管理为中心,对医院医保住院患者管理的流程实施优化,不断规范医院医保住院管理补充流程,加强住院医保费用管理与其他部门之间的衔接,强化医院管理环节的培训,能提高医院的效率和可持续发展。
Objectives To conduct an actual investigation on the management work of medical insurance costs in public hospitals, puts forward countermeasures and plans on the problems in the work process, and research the management effect of medical insurance costs centered on process management. Methods 40 medical insurance patients were selected from each of the 100 public hospitals in both sides of the Pearl River randomly from July 2013 to July 2014. The patients were grouped into two groups according to whether applied process management, with 2200 cases applied and 1800 cases were not, then investigated the hospitalization costs, satisfaction and various aspects of convergence rate. Results There were 45 had no process management, costs（including costs include hospitalization, diagnostic fees, surgery, drugs, examination fee） per family was 280.9±103.4 million, or patient satisfaction was 74.83%, in all aspects of diagnosis and treatment process convergence rate of 24.44%;there are process management has 55, it costs an average of 180.7±68.2 million, or patient satisfaction was 90.91%, in all aspects of diagnosis and treatment process of convergence was 69.09%. Medicare cost process management groups,patient satisfaction, convergence rate and no comparison process management group with significant difference（P〈0.05）. Conclusions Through measures such as centered on process management, implemented the optimization to the hospital health care costs management process, standardized the added process of hospital medical insurance management constantly, and strengthened the cohesion between the hospital health care costs management and other departments as well as the training of hospital management links, thus could we improve the efficiency and realize sustainable development of the hospital.
出处
《中国病案》
2016年第7期65-67,共3页
Chinese Medical Record
关键词
流程管理
住院
医疗保险
费用
Process management
Hospitalized
Medical insurance
Costs
