北京某三甲医院医保基金双层PDCA闭环管理实践与探索

Practice and exploration of double-layer PDCA closed-loop management of medical insurance fund in a Grade III hospital in Beijing

在严格的法律法规监管和大数据分析应用于战略决策的背景下,医疗保险基金管理从经验性走向科学性是大势所趋。在此背景下,首都医科大学附属北京安贞医院提出了双层PDCA闭环式管理模式,以提高医疗保险基金的管理水平,在规范诊疗行为、减少医保拒付及避免经济纠纷等方面取得了较好效果。

In the context of strict legal and regulatory supervision and the application of big data analysis for strategic decision-making,it is a trend to move from empirical to scientific management of medical insurance fund.In this context,Beijing Anzhen Hospital,affiliated to Capital Medical University,has proposed a double-layer PDCA closed-loop management model to improve the management of medical insurance fund,which has achieved better results in regulating treatment behavior,reducing medical insurance rejections and avoiding economic disputes.