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目的探讨医保管理纳入医院质量与安全管理的成效,并为医保管理工作的有序开展和可持续发展奠定重要基础。方法从质量管理组织、队伍建设、规范流程、完善评价管理体系四方面入手,进一步实现医院医保管理质量和安全管理的新发展。结果医保管理纳入医院质量与安全管理体系之中,取得良好的发展成效,主要表现在医疗费用呈现良好发展态势、医保拒付金额比例逐渐下降和医疗资费比例逐渐下降这三方面。结论将医保管理纳入医院质量与安全管理体系之中,能够为医院医保管理工作的可持续发展提供重要的管理框架,符合当前医院管理体系改革的发展形势。
Objective To explore the effectiveness of health insurance management in the quality and safety management of hospitals and lay an important foundation for the orderly and sustainable development of health insurance management. Methods Starting from four aspects of quality management organization, team building, standardization process and perfecting evaluation management system, the further development of hospital medical insurance management quality and safety management is realized. As a result, the medical insurance management was included in the quality and safety management system of the hospital and achieved good results. The main achievements were health care expenses, a gradual decline in the proportion of medical bills, and a gradual decline in the proportion of medical expenses. Conclusion The inclusion of health insurance management in the hospital quality and safety management system can provide an important management framework for the sustainable development of hospital health insurance management and is in line with the current development of the hospital management system reform.