按病种付费模式对医院医保管理的影响

The effect of payment by disease on the management of hospital medical insurance

新形势下,随着我国医疗事业的高速发展,医保制度建设也在不断优化完善,按病种付费作为医保支付方式改革的趋势,是医保基金管理部门抑制医疗费用过快增长的重要手段,医院作为按病种付费模式的管理者和执行者,应该不断深化内部改革,优化管理模式。笔者通过介绍广西按病种付费模式的特点,分析当前形势下按病种付费模式的推行给医院医保管理带来的影响,并提出相应的管理模式转变方向,对医院做好医保管理工作有一定的借鉴意义。

Along with the rapid development of China’s medical services under the new situation,the establishment of medical insurance system has been constantly optimized and improved. As the trend of payment pattern reform of medical insurance,the disease-based payment is a powerful tool for the management of Medicare Fund to control increase of medical cost. The hospitals as managers and executives of payment by disease should constantly deepen the internal reform and optimized management patterns. In the current situation,the author analyzes the impact of the implementation of payment by disease on hospital medical insurance management through conferring the characteristics of payment by disease in Guangxi,and puts forward the corresponding transformation direction of management mode,which has some referential meaning on the hospital medical insurance management.