摘要
目的:探讨在总额预付制下,通过将医保总额按(疾病)诊断相关分组病种和科室进行分解,了解医院医保费用在使用过程中出现的主要问题,评估医疗费用的增长是否合理,最终达到医保总额的可控使用。方法:医院对医保总额预算资金进行相关因素的分解,对临床科室的工作量、治疗周期及治疗均费等指标计算各个科室的各个主要病种应占医保资金额度的具体百分比,对医院的医保预算总额进行分配,将医保总额基金的使用细化。结果和结论:通过将医保总额进行分解,医院才能够将医保费用使用的情况加以分析和评估,及时获得医院在使用医保金额的总体情况和引起医保金额变化的主要因素,通过分析费用变化的原因是合理因素引起的还是非合理因素引起的,发现医保资金使用中存在的问题并加以解决。
Objective： To explore the main problems of hospital health care costs in the use process, evaluate whether the growth of medical expenses was reasonable and finely reach the controlled use of the total amount of health care under the global budget system. Methods： The hospital related factors of total health budget decomposition, workload, period of treatment, and treatment expenses of clinical departments were applied to calculate the proportion of different main diseases of each clinics so as to allocate the medi- cal insurance budget amount of hospitals and elaborate the usage of medical insurance global amount. Results and Conclusion： Through decomposing the total medical insurance expenses, the usage of health insurance expenses could be analyzed and evaluated so as to acquire the usage situation of health insurance expenses and the main factors for the changes of medical insurance amount. Through analyzing the changes of expenses resulted by reasonable factors Or unreasonable factors, the existing problems of medical in- surance fund usage were explored and solved.
作者
郭燕莹
朱光炜
韦昕烨
李淑雯
GUO Yan-ying ZHU Guang-wei WEI Xin-ye et al.(Liuzhou Worker＇s Hospital, Liuzhou, Guangxi, 545005, Chin)
出处
《中国卫生经济》
北大核心
2017年第2期23-25,共3页
Chinese Health Economics
