加强医院医保管理 有效控制费用增长

目的为适应医保的总量控制和次均费用同时控制的管理方法,有效地控制医疗费用的增长。方法从广泛宣传和学习医保政策、制定管理措施及管理指标、建立科室定额控费管理制度、动态监测和反馈医疗费用信息、加强费用的环节管理和终末管理等措施着手,强化医院内部医保管理工作。结果门诊和出院病人的次均费用环比增长速度放缓,全市二级以上医院的医保住院次均费用我院为最低;3年来自负费用率不仅控制在指标范围,且呈逐年下降趋势;各项管理指标全部达标。结论建立科学的费用控制体系,是合理控制费用的关键;控制费用是长期行为,必须持之以恒。

To Strengthen the Management of Medicare in Hospital and Effectively Control the Increase of Medical Expenses

Aim ： In order to conform to the managing way of controlling, at the same time, of both the total expenditure of Medicare and the average expenses of per person, and effectively control the increase of the Medicare expenses. Method ： Making a start on the following measures ： the study and wide publicity about the policy of Medicare, laying down the managing steps and target, setting up the managing system of the expense contro]ling quota in each section and department and the information of dynamic monitoring and the feedback of medical expenses, and tightening up aspects and terminal management of the expenses. By so doing, we have strengthened the Medicare management within our hospital. Result ： The increase speed of the ring ratio of the average expense for per outpatient and inpatient discharged has been slowdown. The average expense for per Medicare inpatient in our hospital has been the lowest in all hospitals within the city of Nantong. For the past three years, the patient＇s own expense ratio has been not only controlled within the limits of the quota, the ratio has but also reduced year by year. And all of the quotas for all of the items have been up to the standard. Conclusion ： To establish a scientific expense - controlling system is the key of the reasonable expense controlling. The expense controlling is a long - term action, which must be carried out unremittingly.