医保基金总额控制下医院医保精细化管理实践与效果分析

An analysis of the practice and effect of fine management of hospital medical security under an overall control of the total amount of medical security fund

目的探究在医保基金总额控制下航空总医院对医保进行精细化管理的实践与效果。方法利用2015~2018年航空总医院的职工医保患者数据,纵向和横向比较2016年医保精细化管理实施前后主要监控指标的变化。结果实施总额控制下的医保精细化管理后,在保证服务质量的前提下,基本医疗保险费用控制效果明显,医保基金使用也更加合理。结论医保精细化管理有利于医院在总额控制下合理利用医保基金和加强医保质量指标控制。

Objective To explore the practice and effect of fine management of medical security in General Hospital of China Aviation under an overall control of the total amount of medical security fund.Methods With the data of the employee patients'medical security of General Hospital of China Aviation from 2015 to 2018,major monitoring indicators before and after the implementation of refined medical security management in 2016 were compared vertically and horizontally to reveal the changes.Results Since the fine management of medical security under an overall control of the total amount was implemented,the cost control effect of basic medical security was obvious and the use of medical security fund became more reasonable on the premise of ensuring service quality.Conclusion Fine management of medical security is conducive to the rational use of medical security funds by hospitals and to strengthening the control of medical security quality indicators under an overall control of the total amount.