浅论医院控制医保患者住院费用的实践

Analysis of Practice of Hospitalization Cost of Hospital Controlled Medical Insurance Patients

目的对医院控制医保患者住院费用的实践进行研究。方法对该院2009—2016年的医保患者住院费用进行统计,对基本医保患者住院费用控制的实践过程进行评述,并探讨该办法控制医保住院费用的优缺点。结果第一个阶段2009年,处于探索时期;第二个阶段2010—2012年,2010年加强了考核的标准,2011年医保结算中心的考核标准有了部分提高,2012年医院的平均治疗费用保持下降趋势;第三个阶段2014年到现在,2014年提升医院的考核标准,医院的治疗费用达到了新高,2014—2016年,医院的医保管理对考核指标进行了强化,坚持费用评价,医院的医保总额超预算的情况有了明显改善,医保费用控制在了规定标准内。结论对医保患者住院费用控制存在着多方面的限制因素,按照专科性质统计各个科室的医保治疗费用,并与个别重症病例相结合,进行了强化考核并不断改进考核内容,可以对医保患者住院费用实现有效的控制。

Objective To research the practice of hospitalization cost of hospital controlled medical insurance patients.Methods The hospitalization cost of medical insurance from 2009 to 2016 was counted,and the practice course of hospitalization cost control of patients with basic medical insurance was evaluated and the disadvantages and advantages of the method controlling the medical insurance were explored.Results 2009 was an exploration period,during 2010 to 2012,the examination standards are enhanced in 2010,and the examination standards have been partially improved in the medical insurance accounting center in 2011,and the average treatment cost took on a decreasing trend in 2012,during 2014 to now,the hospital examination standards were improved in 2014,and the hospital treatment cost reached the highest,during 2014 to 2016,the examination indicators were intensified in the hospital medical insurance management,and total sum of medical insurance in the hospital was obviously improved,and the medical insurance cost was controlled in the specified standards.Conclusion There are many limitations in the hospitalization cost control of medical insurance patients,and we should count the medical insurance treatment cost in each department according to the specific nature,combine it with the individual severe cases,enhance the examination and constantly improve the examination contents,thus effectively controlling the hospitalization cost of medical insurance patients.