医、保、患三方沟通闭环管理促进医保工作改进的实践探索

Practical Exploration of Closed-loop Management of Communication between Medical,Insurance and Patient to Promote Medical Insurance Work

目的为了加强医院临床医生、患者及医保管理中心的有效沟通和管理,促进医保工作高效实施,方便患者就医。方法通过规范自身沟通用语、不断对患者更新医保知识、加大对医务人员的培训、建立医保满意度测评表以及建立医保信息平台的改革方式,通过统计学处理不断改进。结果闭环沟通管理模式下患者医保满意度以及医生政策知晓度提高,差异有统计学意义(P<0.05);医保绩效分数逐年下降。结论该院医保管理科采用“医、保、患”3个角度沟通的闭环管理模式,促进了医保工作的改进,提高了医保服务质量。

Objective In order to strengthen the effective communication and management of hospital clinicians,patients and medical insurance management center,promote the efficient implementation of medical insurance work,and facilitate patients to seek medical treatment.Methods Through standardizing their own communication language,constantly updating medical insurance knowledge for patients,increasing the training of medical staff,establishing medical insurance satisfaction evaluation form,and establishing medical insurance information platform reform methods,continuous improvement through statistical processing.Results Under the closed-loop communication management mode,patient medical insurance satisfaction and doctors’policy awareness increased,the difference was statistically significant(P<0.05);medical insurance performance scores decreased year by year.Conclusion The medical insurance management department of the hospital adopts a closed-loop management mode of communication from three perspectives of"medical,insurance,and patient",which promotes the improvement of medical insurance work and improves the quality of medical insurance services.