病案管理在医疗保险中的作用

The role of medical records in health insurance

医疗保险改革在医疗费用偿付形式上实行“动态均值定额结算”的后付制支付款形式，是建立在疾病种类核算基础上。加强病案管理，对保证医疗保险制度实施起到重要作用。主要表现在病案为制定和修订病种医疗保险费用标准提供可靠依据，有利于医疗保险审核和特殊病种的费用分析，有利于协调医疗保险机构、医疗单位和参保单位的关系。

Based on diseasespecified accounting, a post payment system named dynamic average quota payment is used in health insurance reform. Enhanced management of medical records is important to help implement health insurance regulations, because medical records provide reliable information for setting and modifying diseasespecified cost standards in health insurance, auditing health insurance accounts and diseasespecified costs analysis, and help coordinate the relationship in health insurance agencies, medical institutions and enrollee institutions.