基于医保管理的高值医用耗材管理实践探讨

Standardized management of high-value medical consumables based on medical insurance platform

目的:探讨医院高值医用耗材在医保管理中的规范化管理实践。方法:介绍高值医用耗材在医用耗材中的界定,分析医疗机构高值医用耗材在现行医保管理中所存在的问题。从准入与采购管理、高值医用耗材审批、组织医保政策培训、建立高值医用耗材考核评价体系等方面论述规范医保管理中的高值医用耗材管理。结果:通过科学规范化管理,医院人均医用耗材增长幅度减缓,住院医用耗材总量得到控制,国产化率有所提高。结论:各大医疗机构应以信息平台为支撑,以管理规定与制度为依据,以完善的审批流程为关键环节,以科学考核评价体系为手段,去除高值医用耗材不合理增长因素,保障医保基金的合理使用,降低医疗费用,减轻患者负担。

Objective To explore the standardized management of high-value medical consumables during medical insurance management. Methods The definition of high-value medical consumables was introduced, and the problems of high-value medical consumables were analyzed in medical insurance management. The standardized management of highvalue medical consumables was discussed from the aspects of admission and purchase management, approval of high-value medical consumables, training on medical insurance policies, construction of high-value medical consumables examination and evaluation. Results Standardized management of high-value medical consumables contributed to slowing down the increase of per capita medical consumables, controlling the amount of medical consumables during hospitalization and increasing the ratio of domestic consumables. Conclusion All the medical facilities have to avoid irrational increase of highvalue medical consumables to utilize medical insurance fund reasonably with involvement of information platform,management regulation, approval flow as well as examination and evaluation system.