摘要
医疗保险制度改革是我国医疗改革的核心之一,DRG支付制度作为一种基于病种分组的医疗服务付费方式,被广泛应用于国际医疗保险领域。在DRG支付改革背景下,医院医保部门的作用逐渐受到重视。因此,通过对DRG支付制度的介绍及其对医保部门的影响进行探讨,为医院医保部门适应DRG支付改革提供借鉴和参考。首先,介绍了DRG支付制度的背景、目的和特点;随后分析了DRG支付制度对医院医保部门的影响,包括医保部门组织架构的调整、医保部门职责的变化、医保部门的信息系统建设、对病案管理的职责影响、医保部门人员素质的提高等方面;最后,提出了适应DRG支付改革的建议,包括完善医院内部的信息系统建设、加强医保部门的专业化培训和能力建设、建立科学合理的医疗服务价格体系、加强医保部门与临床部门的合作等。
The reform of medical insurance system is one of the cores of China’s medical reform.DRG payment system,as a medical service payment method based on diseases,is widely used in the international medical insurance field.Under the background of DRG payment reform,the role of hospital medical insurance department has gradually been taken seriously.Through the introduction of the DRG payment system and its influence on the medical insurance department,this paper aims to provide reference for the hospital medical insurance department to adapt to the DRG payment reform.This paper first introduces the background,purpose and characteristics of the DRG payment system,then analyzes the DRG payment system on the hospital health care department,including the organization structure adjustment,the change of the health care department responsibility,the department of the information system construction,the responsibility of medical record management,the improvement of health care department personnel quality,etc.Finally,this paper puts forward suggestions to adapt to the DRG payment reform,including improving the information system construction within the hospital,strengthening the professional training and capacity building of medical insurance departments,establishing a scientific and reasonable medical service price system,and strengthening the cooperation between medical insurance departments and clinical departments.Through the discussion of the work content of the hospital medical insurance department under the background of DRG payment reform,it aims to provide useful reference and suggestions for the reform of the medical insurance system.
作者
邹阿雪
ZOU Axue(Wenzhou Integrated Traditional Chinese and Western Medicine Hospital,Wenzhou 325000,China)
出处
《经济研究导刊》
2024年第18期144-147,共4页
Economic Research Guide
关键词
医疗保险制度改革
DRG支付制度
医院医保部门
Reform of medical insurance system
DRG payment system
Hospital health care department
