医护人员对医保质量与安全管理体系的评价分析

Evaluation of Medical Staff on Medical Insurance Quality and Safety Management System

目的了解医护人员对医保质量与安全管理体系的评价情况,有效推进全面医保质量管理。方法随机抽取广西某三甲医院200名医护人员就医保质量与安全管理体系的评价进行面对面问卷调查,并抽取该院20名医保管理人员进行定性访谈法。结果85.6%的被调查者反映医保质量与安全管理体系增加了医务人员的工作负担,70.5%的被调查者认为该体系限制了适宜技术、诊疗、护理措施的选择,60.8%的被调查者认为该体系不利于缓和紧张的医患关系;大部分被访谈者认可医院医保质量与安全管理体系为医保管理工作带来的有效性和实用性,同时也指出其在人员配备、信息化建设、指标制定等方面存在的不足。结论医院医保质量与安全管理体系的建设需因地制宜,个性化考核,同时借助信息化平台推进精细化管理,实行医保大数据挖掘。

Objective To understand the evaluation of medical insurance staff on the quality and safety management system of medical insurance,and effectively promote comprehensive medical insurance quality management.Methods Randomly selected 200 medical staff from a top three hospital in Guangxi to conduct a face-to-face questionnaire survey on the evaluation of medical insurance quality and safety management system,and selected 20 medical insurance managers from the hospital for qualitative interviews.Results 85.6%of the respondents reported that the medical insurance quality and safety management system increased the workload of medical staff.70.5%of the respondents believed that the system limited the choice of appropriate technology,diagnosis and nursing measures,and 60.8%of the respondents that this system is not conducive to easing the tense doctor-patient relationship;most of the interviewees recognized the effectiveness and practicability of the hospital medical insurance quality and safety management system for medical insurance management,and also pointed out that there are deficiencies in the formulation of indicators in staffing,information construction.Conclusion The construction of hospital medical insurance quality and safety management system needs to be tailored to local conditions and personalized assessments.At the same time,the information platform will be used to promote refined management and implement medical insurance big data mining.