创新医保管理的做法与影响研究

目的研究分析医院在医保管理工作中,开展临床路径管理模式下的创新型医保管理措施的效果。方法将随机抽选的2018年7-12月在该院住院治疗的80例住院类别为居民医疗保险的患者设为对照组,对照组均未实施临床路径管理模式下的创新型医保管理。随机抽选同期在该院住院治疗的另外80例住院类别为基本医疗保险的患者设为观察组,观察组均实施临床路径管理模式下的创新型医保管理。对比两组患者不同医保管理模式下的服务满意度以及住院费用支出和个人费用负担情况。结果观察组中服务满意度显著比对照组要高,观察组中各相同科室相同病种患者次均住院费用及个人次均费用负担明显低于对照组(P<0.05)。结论在医院医保管理工作中,通过采取临床路径管理模式下的创新型医保管理措施,有效控制了患者住院费用的支出,遏制了不合理费用的增长,降低了患者个人的费用负担;明显改进了对患者的医保服务质量,提升了患者的服务满意度。

Research on the Practice and Impact of Innovative Medical Insurance Management

Objective To study and analyze the effect of innovative medical insurance management measures under the clinical path management model in the medical insurance management work of the hospital. Methods A random selection of80 patients admitted to the hospital from July to December 2018 in the hospitalization category as residents’ medical insurance was set as the control group. None of the control groups implemented the innovative medical insurance under the clinical path management mode management. Another 80 patients who were hospitalized in our hospital during the same period were randomly selected as the observation group, and the observation group implemented the innovative medical insurance management under the clinical path management mode. The service satisfaction, hospitalization expenses and personal expenses burden of the two groups of patients under different medical insurance management modes were compared. Results The service satisfaction in the observation group was significantly higher than that in the control group. The average hospitalization cost and individual cost burden of patients with the same disease in the same departments in the observation group were significantly lower than those in the control group(P<0.05). Conclusion In the hospital medical insurance management work, by adopting innovative medical insurance management measures under the clinical path management mode,the patient’s hospitalization expenses were effectively controlled, the increase of unreasonable expenses was curbed, and the individual patient’s cost burden was reduced. The quality of medical insurance services for patients is improved, and the service satisfaction of patients is improved.