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目的探讨社保病种分组错误的解决办法。方法分析医师对社保住院病人病种申报分组的错误原因,提出相应的解决办法。结果分组错误的原因有主要诊断选择错误、未掌握特殊病种的限制条件和漏报,相应的对策有加强有关知识的学习、派专人审查病种的申报、改每月核查为每天核查、实行网络直报。结论网上直报+全部社保病例申报+每天专人核查的模式是社保病种分组错误的最终解决方案。
Objective To explore the solutions to the grouping errors of social security patients. Methods Analyze the errors of physicians on subgroups of inpatients of social security inpatients and put forward corresponding solutions. Results The main reason for grouping errors is wrong diagnosis, failure to grasp the limitations and omissions of special diseases. Corresponding measures include strengthening the study of relevant knowledge, sending specialists to examine the application of the disease types, changing monthly verification to daily verification and implementing Network direct report. Conclusion Online direct reporting + reporting of all social security cases + verification by hand every day is the final solution to grouping social security sickness cases.