摘要
该文基于疾病诊断相关分组(diagnosis related group,DRG)付费改革背景下福建医科大学附属南平第一医院开展三医联动的工作实践,梳理院内三医联动的内涵与外延,包括概念界定、组织架构、DRG付费与三医联动的关系等内容,并从医疗质量管理、医疗保险(医保)管理、医疗药物/耗材管理、绩效评价4个方面总结三医联动工作机制的具体举措和所取得的积极成效。这些经验对于提升医疗质量与效率、积极应对医保支付方式改革、提升公立医院医疗服务水平、实现医保管理部门、医院、患者三方共赢具有重要意义。
This article is based on the work practice of Medical-lnsurance-Medicine Linkage carried out by the Nanping First Hospital Affiliated to Fujian Medical University under the reform of payment based on diagnosis related group(DRG).It outlines the connotation and extension of Medical-lnsurance-Medicine Linkage in the hospital,including concept definition,organizational structure,the relationship between DRG payment and Medical-lnsurance-Medicine Linkage,and summarizes the specific measures and positive results of the Medical-lnsurance-Medicine Linkage work mechanism from four aspects:medical quality management,medical insurance management,medical drugs/consumables management,and performance evaluation.These experiences are of great significance for improving the quality and efficiency of medical care,actively responding to the reform of medical insurance payment methods,enhancing the level of medical services in public hospitals,and achieving a win situation among the medical insurance management departments,hospitals,and patients.
作者
徐尚华
董四平
蒋凌
黄琦磊
赖乐涵
XU Shanghua;DONG Siping;JIANG Ling;HUANG Qilei;LAI Lehan(Department of Cardiovascular,Nanping First Hospital Affiliated to Fujian Medical University,Nanping,Fujian 353000,P.R.China;National Institute of Hospital Administration,National Health Commission,Beijing 100044,P.R.China;Department of Quality Management,Nanping First Hospital Affiliated to Fujian Medical University,Nanping,Fujian 353000,P.R.China)
出处
《华西医学》
CAS
2023年第12期1885-1889,共5页
West China Medical Journal
基金
福建省卫生健康科技计划项目软科学研究项目(2022RKA016,2021RKA014)。
关键词
医疗保险支付方式改革
疾病诊断相关分组
三医联动
医疗质量
多部门协作
Medical insurance payment reform
diagnosis related group
Medical-lnsurance-Medicine Linkage
medical quality
multi-disciplinary team
