江苏省医院协会2021年度医院管理创新专项研究项目（JSYGY-3-2021-PJ124）
目的：探讨县级三级公立医院在DIP支付方式改革背景下开展医保运营效率管理。方法：以2021年和2022年某县三级公立医院出院病例为研究对象，完善医院医保运营管理组织架构，优化收治病种结构，强化成本管控，对比分析运营效率及运营质量指标。结果：与2021年相比，2022年住院病人次均费用提高了1.99%，住院次均药品费用提高1.20%，住院收入中来自医保基金的收入提高3.75%，同时手术占比提高0.74个百分点，微创手术占比提高1.12个百分点。结论：DIP支付方式下县级三级公立医院通过完善组织架构、提升医疗内涵、强化成本管控及优化绩效考核，可有效提升运营效率，促进医院医疗质量指标的改善。
Objective：To explore the efficiency management of medical insurance operation in county-level tertiarypublic hospitals under the background of DIP payment mode reform. Methods：Taking the discharged cases in 2021 and 2022 in a certaincounty-level tertiary public hospitalas the research object，the hospital improved the organizational structure of medical insurance operation and management，optimized the structure of patients admitted，strengthened cost control and so on，and compared and analyzed some operational efficiency and operational quality indicators. Results：Compared with 2021，the average cost of inpatients in 2022 increased by 1.99%，the average cost of drugs in inpatients increased by 1.20%，and the income from medical insurance fund increased by 3.75%. Meanwhile，the proportion of surgery increased by 0.74 percentage points and that of minimally invasive surgery increased by 1.12 percentage points. Conclusion：Under the DIP payment mode，the county-level tertiarypublic hospitals can effectively improve the operation efficiency by improving the organizational structure，improving the medical connotation，strengthening the cost control and optimizing the performance assessment，and also well promote the improvement of the hospital’s medical quality index.