医院医保费用关键考核指标构建

目的探讨总额预付制下某三级甲等综合医院内部医保费用关键考核指标的构建方法,评价其实施后的医保费用控制效果。方法通过德尔菲法专家咨询构建关键考核指标,通过对该院实施费用指标管理前后医保费用核心指标的变化进行统计学分析,评价医保费用管理成效。结果形成了3个一级指标、10个二级指标、27个三级指标的关键指标体系。该院实施费用指标管理后医疗服务效率明显提升,医保门急诊均次费用及药品均次费用显著下降,医保住院药占比较前降幅显著,医保门急诊及住院诊疗人次显著增加。结论总额预付制下医院实施医保费用关键指标管理,对于合理控制医保费用有着重要意义。

Establishment of Key Performance Indicators in the Hospital to Control Medical Insurance Expenditures

Objective To explore the way to construct key performance indicators to control the medical insurance expenditures,and to evaluate the effectiveness after implementing the indicators system. Method Delphi expert consultation was used to build up key performance indicators system. The data of indicators were analyzed before and after the implementation of the indicators system in hospital management. Results The key indicators system included three first grade indices,10 second grade indices and 27 third grade indices. After the implementation of indicators system,the medical service efficiencies were improved significantly： the outpatient per-capita costs,average drug cost and average drug cost of inpatients drop dramatically while both inpatients and outpatients person-time increase dramatically. Conclusion In global budget payment system,the management of key performance indicators of hospital costs was of important significances on medical costs control.