医保多控管理纳入地级医院综合质量管理后的效果分析

Effect analysis of incorporating multiple control management of medical insurance into comprehensive quality management in prefecture hospitals

为有效控制医保统筹基金,将医保统筹定额实行定额管理,即根据各科室分配的年统筹基金定额,合理控制药占比、耗材占比、平均住院日等,进行上述"多控管理"后,医保统筹基金得到了有效控制。认为解决医保统筹基金增长过快的关键在于医院综合管理控制。

Quota management was adopted to control the medical insurance pooling fund effectively. Depending on the yearly quota medical insurance pooling fund allocated to each department, proportion of drug cost ratio, consumables cost ratio, and average length of stay were controlled. With the ‘multiple control management’, effective control of the medical insurance fund was achieved. We found hospital comprehensive management and control is the key to solve the problem about rapid growth of medical insurance pooling fund.