摘要
目的通过调查专科医院出院医保病历质量,分析原因,提出对策。方法随机抽取2014年出院医保病历530份,以上海市收费标准及医保政策法规为依据,对出院病历进行逐项检查,统计分析不合理类型,并与2015年改进后的530份医保病历进行对比分析。结果所选530份出院病历中不合格病历检出率为17.55%(93/530),其中不合理收费所占比例较高,占据不合理病历数的49.5%。医保病历改进后的2015年不合格病历检出率(6.60%)明显低于改进前2014年不合格病历检出率(17.55%),差异有统计学意义(P<0.05)。结论医保工作应重视医保病历质量,以医保病历为抓手,落实医保政策,保障参保人的利益,减少医保拒付。
Objective By investigating specialized subject hospital health care medical records quality,analysis the reason,countermeasures are put forward.Methods Randomly selected2014health care medical records of530hospital,fee standards and health policy and regulations in Shanghai,on the basis of the hospital medical records to check item by item,type of statistical analysis is not reasonable,and the improved530and2015health care medical records were analyzed.Results The selected530discharged medical records in the unqualified case detection rate was17.55%(93/530),including unreasonable charge proportion is higher,about49.5%of the unreasonable medical record number.Improved health care medical records of2015unqualified medical records before detection rate(6.60%),significantly lower than the improvement in2014unqualified case detection rate(17.55%),the difference was statistically significant(P<0.05).Conclusion The health care work should pay attention to health care quality of medical records,with health care medical records as the gripper,the implementation of health policy,protect the interests of the people,to reduce health care to refusal of payment.
作者
林华军
李言平
Lin Hua-jun;Li Yan-ping(Department of Medical Education, The Third Affiliated Hospital of Second Military Medical University, Shanghai, 201805, China)
出处
《当代医学》
2017年第13期10-12,共3页
Contemporary Medicine
关键词
医保
病历质量
医疗干预
Health care
Medical record quality
Medical intervention
