探讨PDCA循环在医院医保管理中的运用

Discussion on the Application of PDCA Cycle in Hospital Medical Insurance Management

目的分析在医院医保管理的过程中,对其实行PDCA循环模式的应用及效果。方法选取2018年8月—2019年10月102例该院新入医保住院患者作为研究对象,采用无差别分类法将其进行分组,即研究组(PDCA循环医院医保管理模式)、常规组(传统医院医保管理模式)各51例,对比两组患者的咨询满意度、相关医保管理指标(住院总费用、住院时间)以及医保报销比例(城镇职工医保报销比例、城乡居民医保报销比例)情况。结果PDCA循环管理模式实施后,研究组患者的咨询满意度明显高于常规组,差异有统计学意义(P<0.05);PDCA循环管理模式实施后,研究组患者的相关医保管理指标(住院总费用、住院时间)均低于常规组,差异有统计学意义(P<0.05);PDCA循环管理模式实施后,研究组患者的医保报销比例(城镇职工医保报销比例、城乡居民医保报销比例)高于常规组,差异有统计学意义(P<0.05)。结论PDCA循环管理模式的实施,能明显提高医保住院患者的咨询满意度,同时大幅度减少该疾病患者的住院总费用,缩短住院时间,且在此基础上,有效提升其城镇职工医保与城乡居民医保报销比例,效果显著。

Objective To analyze the application and effect observation of the PDCA cycle model in the process of hospital medical insurance management.Methods A total of 102 newly admitted medical insurance inpatients in the hospital from August 2018 to October 2019 were selected as the research objects.The non-discriminatory classification method was used to divide them into groups,namely the study group(PDCA circulating hospital medical insurance management model)and the routine group(traditional hospital medical insurance management model)with 51 cases each.Compared the two groups of patients'consultation satisfaction,related medical insurance management indicators(total hospitalization expenses,length of stay),and medical insurance reimbursement ratio(urban employee medical insurance reimbursement ratio,urban and rural residents medical insurance reimbursement ratio).Results After the implementation of the PDCA cycle management model,the consultation satisfaction of patients in the study group was significantly higher than that in the convention group,the difference was statistically significant(P<0.05).After the implementation of the PDCA cycle management model,the relevant medical insurance management indicators(total hospitalization cost,length of stay)of the study group of patients were lower than those of the convention group,the difference was statistically significant(P<0.05).After the PDCA cycle management model was implemented,the medical insurance reimbursement ratio of patients in the study group(urban employee medical insurance reimbursement ratio,urban and rural residents medical insurance reimbursement ratio)was higher than that of the convention group,the difference was statistically significant(P<0.05).Conclusion The implementation of the PDCA cycle management model can significantly improve the consultation satisfaction of medical insurance inpatients.At the same time,the total cost of hospitalization for patients with this disease is greatly reduced,and the length of hospitalization is shortened.And on this basis,it has effectively increased the reimbursement ratio of its urban employee medical insurance to urban and rural residents'medical insurance,and the effect is significant.