| 摘要: |
| 目的：探讨研究医院在医保控费管理以及精细化管理中应用病种分值付费模式后产生的效果。方法：对医院在实施病种分值付费模式管控前后的患者住院相关数据进行对比分析。实施前（2020年6月-2021年4月），实施后（2021年5月-12月），研究对比实施前后住院患者的精细化管理（住院时间、住院费用、药品材料耗费等）以及医保基金等相关信息的运用效果。结果：实施前的住院费用以及住院天数高于实施后，医保基金结余低于实施后，比较统计值P < 0.05；实施前的手术费、麻醉费以及基本医疗外费用与实施后比较，差异无统计学意义（P > 0.05）。实施前后的病患重复住院率比较降低0.1%，数据比较差异不明显，P > 0.05。结论：在医院为患者实施病种分值付费模式后，可有效提高医保控费管理和精细化管理的运行效率，对医、保、患具有积极的促进作用。 |
| 关键词: 按病种分值付费模式 医院 医保控费 精细化管理 |
| DOI： |
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| 基金项目: |
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| The Influence of Disease Score Payment Mode in Hospital Medical Insurance Cost Control Management and Fine Management |
| XIE Zhaohui |
| (Medical Department，Xiamen children's Hospital，Xiamen hospital，(The Affiliated Pediatric Hospital of Fudan University）) |
| Abstract: |
| Objective：To explore the application effect of disease score payment mode in hospital medical insurance cost control management and fine management. Methods：The data related to hospitalization of patients before and after the implementation of disease score payment mode in the hospital were compared and analyzed. Before the implementation（fromJune 2020 toApril 2021）and after the implementation（from May 2021 toDecember 2021），to study and compare the fine management of hospitalized patientsbefore and after implementation（hospitalization time，hospitalization expenses，drug and material consumption，etc.）and the application effect of medical insurance fund and other relevant information. Results：The hospitalization expenses and days of hospitalization before the implementation were higher than those after the implementation，and the medical insurance fund was lower than that after the implementation. There was significant difference（P < 0.05）. There was no significant difference in operation cost，anesthesia cost and non basic medical cost between before and after implementation（P > 0.05）. The repeated hospitalization rate of patients before and after the implementation was reduced by 0.1%，and there was no significant difference in data（P > 0.05）. Conclusion：After the hospital implements the disease score payment mode for patients，it can effectively improve the operation efficiency of medical insurance cost control management and fine management，and play a positive role in promoting doctors，insurance and patients. |
| Key words: Payment Mode by Disease Score Hospital Medical Insurance Fee Control Management Fine Management |
