摘要
目的探讨在医疗保险基金全面控制下医院医疗保险精细化管理的实践与效果。方法选择该院2018年1月—2020年12月收治的400例具有医疗保险基金患者为对象,根据入院时间将患者分成精细化管理实施前(n=200)和精细化管理实施后(n=200)。实施前采用常规方法管理,实施后采用精细化管理。比较实施精细化管理前后的医疗纠纷率和投诉率、医院医疗保险管理达标率。结果实施后的医疗纠纷率和投诉率低于实施前,差异有统计学意义(P<0.05)。实施后的医院医疗保险管理达标率高于实施前,差异有统计学意义(P<0.05)。结论在医疗保险基金全面控制下医院医疗保险精细化管理的可行性高,能减少医疗纠纷和患者投诉率,并能提高工作人员的精细化管理能力,确保每项医院医疗保险管理工作有效达标。
Objective To explore the practice and effect of the refined management of hospital medical insurance under the full control of the medical insurance fund.Methods The 400 patients with medical insurance funds admitted to the hospital from January 2018 to December 2020 were selected as subjects.According to the time of admission,the patients were divided into pre-refined management(n=200)and post-refined management(n=200).Before implementation,conventional methods are adopted for management,and after implementation,refined management was adopted.Compared the medical dispute rate and complaint rate before and after the implementation of refined management,and the hospital medical insurance management compliance rate.Results The medical dispute rate and complaint rate after implementation were lower than before implementation,the difference was statistically significant(P<0.05).The hospital medical insurance management compliance rate after implementation was higher than before implementation,the difference was statistically significant(P<0.05).Conclusion Under the comprehensive control of the medical insurance fund,the fine management of hospital medical insurance is highly feasible,which can reduce the rate of medical disputes and patient complaints,and can improve the fine management ability of staff to ensure that each hospital's medical insurance management effectively meets the standards.
作者
贺文
HE Wen(Medical Insurance Office of Jinan Central Hospital,Jinan,Shandong Province,250013 China)
出处
《中国卫生产业》
2021年第13期81-83,共3页
China Health Industry
关键词
医院医疗保险
精细化管理
医疗保险基金
全面控制
Hospital medical insurance
Refined management
Medical insurance fund
Comprehensive control
