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目的对公立医院医保住院费用管理工作进行切实的调查,就工作中出现的问题提出解决对策和方案,研究以流程管理为中心的医保费用管理效果。方法从珠江两岸100家公立医院中随机选取2013年7月到2014年7月医保住院患者各40人,根据是否实施流程管理进行分组,实施流程化管理2200例和非流程化管理1800例,分别调查两组患者的住院费用、满意度及各环节衔接率。结果无流程化管理的医院45家,费用包括住院费、诊断费、手术费、药品费、检查费等,平均每家医院为280.9±103.4万,患者满意度为74.83%,诊疗流程中各环节衔接率为24.44%;有流程化管理的有55家,费用平均为180.7±68.2万,患者满意度为90.91%,诊疗流程中各环节衔接率为69.09%。流程化管理组的医保费用、患者满意度、衔接率与无流程化管理组对比具有统计学差异(P<0.05)。结论以流程管理为中心,对医院医保住院患者管理的流程实施优化,不断规范医院医保住院管理补充流程,加强住院医保费用管理与其他部门之间的衔接,强化医院管理环节的培训,能提高医院的效率和可持续发展。
Objective To conduct a practical investigation on the management of medical expenses and hospitalization expenses in public hospitals, put forward solutions and solutions to the problems arising in the work, and study the effect of medical expense management focusing on process management. Methods A total of 40 inpatients were randomly selected from 100 public hospitals across the Pearl River Delta from July 2013 to July 2014. Patients were grouped according to whether they were implemented or not, and 2,200 were managed by process management and 1,800 by non-process management respectively Investigation of two groups of patients in hospital costs, satisfaction and the link rate of each link. As a result, there were 45 hospitals without any process management. The costs included hospitalization, diagnosis, surgery, drug fees and examination fees. On average, each hospital was 280.9 ± 1.04 million with patient satisfaction of 74.83% Linkage rate was 24.44%; there were 55 process management, the average cost was 180.7 ± 68.2 million, patient satisfaction was 90.91%, the link rate of the various links in the diagnosis and treatment process was 69.09%. There was a significant difference (P <0.05) between the medical insurance cost, patient satisfaction, cohesion rate and no-process management in the process management group. Conclusion The process management of hospital as the center, the implementation of optimization of the hospital medical insurance inpatient management process, and constantly regulate the hospital medical insurance inpatient management supplement process, strengthen the hospital medical expenses management and other departments link up, strengthen the management of hospital management, can improve the hospital Efficiency and sustainability.