医保按病种分值付费对医院管理的影响及对策

Impacts of payment per disease scoring of medical insurance on hospital management and countermeasures

银川市2015年1月1日开始实行“总额控制下按病种分值结算”住院费用的结算办法。新的结算办法迫使医院必须加强内部自主管理，强化成本控制、落实临床路径、加强医院信息化建设、规范医院医疗信息上传。本研究主要对此结算办法实施的政策背景及对医院内部管理的要求以及医院应对的措施进行阐述和分析，为政府医保管理部门在制定政策具体措施过程中提供参考，也为医院内部及时调整管理模式和工作流程，以便更好地应对和执行政策提出了相应的对策。

Yinchuan city began since January 1, 2015 to implement the＂Disease scoring settlement under total budget＂for hospitalization cost settlement. The new settlement method impels the hospitals to strengthen internal management, strengthen cost control, implement clinical pathway, strengthen the construction of hospital informationization, and standardize the hospital medical information upload. This paper covered the policy background and hospital internal management requirements, as well as hospital response measures, for reference of government heahhcare authorities in the formulation of policy specific measures, and for the hospital＇ s medical insurance management department to adjust management mode and work flow, in order to better respond to and implement the policy.