PDCA循环在军队医院医保综合管理中的应用

Practice of PDCA cycle in the comprehensive management of medical insurance in military hospitals

目的应用PDCA循环理论进行军队医院医保管理。方法针对军队医院医保管理现状,根据PDCA循环理论,建立医保管理计划、实施、检查、处理具体措施,统计分析实施PDCA循环前后医保管理评价指标的变化。结果实施PDCA循环后患者满意度、患者在位率、身份确认率、知情告知签字率、医保政策测试均分均有提高;门诊均次费用、住院均次费用、住院药占比、不合理诊疗例次发生率、不合理诊疗金额占比均有降低;住院报销比例控制在合理水平。结论 PDCA循环管理,进一步规范了诊疗行为,对持续提升军队医院医保管理水平具有重要意义。

Objective Apply PDCA Cycle theory in medical insurance management of military hospitals. Methods Targeting at the current situation of medical insurance management in military hospitals and according to the PDCA Cycle theory,establish the specific measures of medical insurance management plan,implementation,inspection and treatment and statistically analyze the changes of medical insurance management evaluation indexes before and after the implementation of PDCA Cycle. Results After the implementation of PDCA Cycle,patients’ satisfaction,patient occupancy rate,identity confirmation rate,informed notification signature rate,and average score of medical insurance policy test all improved. While Outpatient average cost,inpatient average cost,proportion of inpatient drugs,incidence rate of unreasonable diagnosis and treatment cases and proportion of unreasonable diagnosis and treatment amount all reduced. The proportion of inpatient reimbursement was controlled at a reasonable level. Conclusion PDCA Cycle management has further standardized the behavior of diagnosis and treatment,which is of great significance to continuously improve the level of comprehensive management of medical insurance in military hospitals.