三甲医院临床科室医保质量管理标准调查

Research on criteria of health insurance quality management in clinical departments of tertiary hospitals

目的:探讨三甲医院临床科室医疗保险质量管理标准,为标准的制定提供参考。方法:采用自行设计问卷对医疗保险经办机构、三甲医院医疗保险管理部门、医疗保险行业管理协会的从业人员进行调查,并使用SPSS17.0软件进行数据分析。结果:在238名研究对象中,90.34%的人认为当前临床科室医疗保险质量管理没有或几乎没有统一的标准,71.01%的人认为临床科室医疗保险管理迫切需要统一的质量管理标准;"合规诊疗"和"廉洁自律"被认为是最重要的标准。结论:亟需制定统一的三甲医院临床科室医疗保险质量管理标准。

Objective：To explore the criteria of health insurance quality management in clinical departments of tertiary hospitals and provide references for the criteria.Methods：Self-designed questionnaires were used among staff of the government authorities,health insurance agencies,tertiary hospitals and health insurance associations.Data were analyzed by SPSS17.0.Results：Among the 238 objects,90.34% objects thought there was no or almost no unified criteria of health insurance quality management in clinical departments of tertiary hospitals,71.01% objects thought it was urgent to make a unified criteria.＂Appropriate treatment＂and＂Incorruptible and self-discipline＂were considered as the most important criteria.Conclusion：It is urgent to make unified criteria of health insurance quality management in clinical departments of tertiary hospitals.