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目的:通过对试点医院总量控制政策实施前后的数据进行对比分析,探讨该政策对医保患者住院费用产生的影响,为完善医保总量控制政策提出合理化建议。方法:运用SPSS软件进行秩和检验和卡方检验,比较试点医院总量控制政策实施前后医保患者住院相关指标的变化情况。结果:试点医院总量控制政策实施后,医保服务量、平均住院天数及药占比均有显著变化,次均费用变化情况不明显。结论:试点医院积极配合总量控制政策进行调整,初步效果已经显现,但在工作中要注重医院管理模式的调整,探索按病种付费方式,规范医疗服务流程,合理控制和监督医保总量指标。
OBJECTIVE: To compare and analyze the data before and after the implementation of the total amount control policy in pilot hospitals to explore the impact of this policy on the hospitalization expenses of medical insurance patients, and put forward reasonable suggestions to improve the total amount of medical insurance control policies. Methods: SPSS software was used to conduct rank sum test and chi-square test to compare the change of hospital-related index of Medicare patients before and after the implementation of the total hospital control policy. Results: After the implementation of the total control policy of pilot hospitals, there was a significant change in the amount of medical insurance services, the average days of hospitalization and the proportion of drugs, with no significant changes in the average cost. Conclusion: The pilot hospitals actively cooperate with the total control policy to adjust the initial results have been shown, but in the work we should pay attention to the adjustment of the hospital management mode, to explore ways to pay according to the disease, standardize the flow of medical services, reasonable control and supervision of the total health insurance targets .