医保投诉及医院管理因素影响的评价

The assessment of medical insurance petition and hospital management factors

目的:分析医保投诉问题,从中查找医院管理因素的影响,强化医院职能和绩效考评办法,确保医疗工作正常秩序。方法:对照分析2011年及2012年度管理前后医保投诉问题的指标变化。结果:2012年度比2011年度住院患者增加了5223人,投诉总人数减少了111人次,下降了79.86%;门诊刷卡增加393726人次,投诉减少227人次,下降了67.36%,很多具体问题得到了控制。结论:医保投诉是医保管理过程中缺欠问题,主要与医院管理因素有直接关联,完善医院管理至关重要。

Objectives： To analyze medical insurance complaints in order to figure out the influence of hospital management factors, strengthen hospital functions and performance evaluation and to assure the normal order of medical work. Methods：The changes of medical insurance complaints in the years between 2011 and 2012 were compared. Results：The number of hospitalized patients in 2012 increased 5223. The total number of complaints decreased 111, which was fall by 79.86%. The number of patients using medical insurance cards increased by 393,726 but the number of complaints decreased by 227, fell by 67.36%. Many specific problems were under control. Conclusion：Although medical insurance complaints belong to the weakness of medical insurance management, there is direct association with hospital management factors. It is essential to improve hospital management.