医保投诉的影响因素及方案分析

目的分析医保投诉的影响因素及解决方案。方法选取2016年1月-2016年12月、2018年1月-2018年12月分别为对照阶段、观察阶段,分别采取常规医保管理、常规医保管理联合优化管理方案,在两个阶段内各随机选取医保支付医疗费用的患者3000例,设为对照组及观察组,分析投诉发生情况;在对照组及观察组内各随机选取患者300例,分析不同阶段服务质量。结果观察组投诉率低于对照组(P<0.05);观察组满意度评分高于对照组(P<0.05)。结论了解医保影响因素,并予以对症解决方案,能够降低医保投诉率,提升医院服务质量及患者满意度。

Influencing Factors and Program Analysis of Medical Insurance Complaints

Objective To analyze the influencing factors and solutions of medical insurance complaints.Methods From January 2016 to December 2016,and from January 2018 to December 2018,respectively,the control phase and the observation phase were taken respectively.The joint medical insurance management and routine medical insurance management joint optimization management plan were adopted respectively.A total of 3,000 patients who were randomly selected for medical insurance to pay for medical expenses were set as the control group and the observation group to analyze the occurrence of complaints.300 patients were randomly selected in the control group and the observation group to analyze the quality of service at different stages.Results The complaint rate of the observation group was lower than that of the control group(P<0.05);the satisfaction score of the observation group was higher than that of the control group(P<0.05).Conclusion Understanding the factors affecting medical insurance and providing symptomatic solutions can reduce the rate of medical insurance complaints,improve hospital service quality and patient satisfaction.