基于韧性理论的医院医保管理高质量发展模式探索

Exploration of high-quality development mode of hospital medical insurance management based on resilience theory

医保支付方式改革衍生风险在医院管理过程中不可忽视,提升公立医院风险应对能力、以改革为契机寻求发展新路径已成为医院建设的重要内容。以医保支付方式改革影响下的医院管理为重点研究对象,以实现医院高质量发展为目标,引入韧性理论对医院韧性进行界定,结合公立医院管理实践,分析营收韧性、学科建设韧性、数据审查韧性等的医院韧性作用机制,并从提升主体结构韧性、增强过程韧性、强化制度韧性3个层面提出医院韧性建设策略,为医保支付方式改革影响下的医院高质量发展路径提供分析视角及政策建议。

The risk derived from the reform of medical insurance payment methods cannot be ignored in the process of hospital management.Improving the risk response ability of public hospitals and taking the reform as an opportunity to seek a new development path has become an important part of hospital construction.It focuses on hospital management under the influence of the reform of medical insurance payment methods,and aims to achieve high-quality development of hospitals.Through the introduction of resilience theory and the definition of hospital resilience,combined with the management practice of public hospitals,it analyzes the mechanism of hospital resilience,including revenue resilience,discipline construction resilience,data review resilience,etc.Strategies for hospital resilienceconstruction are put forward from three aspects:improving the toughness of main structure,enhancing the toughness of process and strengthening the toughness of system,providing an analyticalperspective and policysuggestions for the high-quality development path of hospitals under the influence of the reform of medical insurance payment methodls.