单病种分值付费管理下的医保智能监管系统的构建
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摘要
为进一步提高医保基金的使用效率,有效控制医保费用的不合理增长,广东省已开始实施医疗保险总额控制下的单病种分值付费模式,该模式对医保费用管理更精细。因病案首页、诊断等众多限制条件,以及严格的审核条件等因素给医院对医保的监管带来困难。为解决这难题,可构建单病种分值付费管理下的医保智能监管系统,采取事前提示、事中监控、事后审核,有效控制住院费用,提高医院的经济效益和社会效益。
In order to further improve the utilization efficiency of medical insurance funds and effectively control the unreasonable growth of medical insurance expenses. Guangdong Province has begun to implement disease-based score payment system under the control of total medical insurance. which is more precise for the management of medical insurance expenses. Because of many restrictive conditions such as the front page, diagnosis and strict examination conditions, it brings difficulties to the supervision of medical insurance. In order to solve this problem, we can construct the medical insurance intelligent supervision system under the charge management of single disease, take the pre prompt, monitoring and post audit, control the hospitalization expenses effectively, and improve the economic and social benefits of the hospital.
In order to further improve the utilization efficiency of medical insurance funds and effectively control the unreasonable growth of medical insurance expenses. Guangdong Province has begun to implement disease-based score payment system under the control of total medical insurance. which is more precise for the management of medical insurance expenses. Because of many restrictive conditions such as the front page, diagnosis and strict examination conditions, it brings difficulties to the supervision of medical insurance. In order to solve this problem, we can construct the medical insurance intelligent supervision system under the charge management of single disease, take the pre prompt, monitoring and post audit, control the hospitalization expenses effectively, and improve the economic and social benefits of the hospital.
引文
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[3]陈曼莉,赵斌.实行按病种分值付费制度的实践经验及启示[J].中国卫生经济,2017,36(6):38-41.
[4]覃森荣,周民伟,李小华,等.医保费用监控平台实施效果评价[J].中国数字医学,2017,12(7):110-112.
[5]袁素华,杨广智.单病种分值付费制下五个病种住院费用的影响因素分析[J].现代医用影像学,2016,25(3):588-591.
[2]杨毕辉.军队医院地方医保基金运行的智能监管实践[J].中国数字医学,2015,10(12):65-67.
[3]陈曼莉,赵斌.实行按病种分值付费制度的实践经验及启示[J].中国卫生经济,2017,36(6):38-41.
[4]覃森荣,周民伟,李小华,等.医保费用监控平台实施效果评价[J].中国数字医学,2017,12(7):110-112.
[5]袁素华,杨广智.单病种分值付费制下五个病种住院费用的影响因素分析[J].现代医用影像学,2016,25(3):588-591.