预算总额控制下的医院医保精益管理实践与成效分析

Analysis of Practice and Result of Delicacy Management of Hospital Medical Insurance under the Total Budget

阐述了精益管理的内涵及其重要意义,概括了2016至2017年南京医科大学附属老年医院在医保预算总额控制下,运用精益管理理念和技术工具在建立医保绩效考核机制、特殊费用精准调控、单病种费用的合理引导和结构优化、医保服务规范化标准化统一、医保政策专题专项辅导以及优化服务流程、完善管理回路等几个方面推进医保精益管理的实践与思考,为医院医保工作开展精益管理提供一定的参考和借鉴。

This article summarized the implementation of delicacy management of medical insurance in Geriatric Hospital of Nanjing Medical University from 2016 to 2017:establishing performance evaluation mechanism with incentive constraints,accurately regulating the line of the specail expense,reasonablely guiding and optimizing the structure of the single-disease expenses,unifying the standardized service specification in medical insrance,launching the special topic analysis session in medical insurance policies,promoting continuous improvement of health service and management processes.It also pointed out that we should exactly grasp the medical policies,systematically and continuously improve the delicacy management in medical insurance management.