[目的]探讨适合公立医院的医疗保险管理手段,在保证医疗质量的同时,做到及时、有效、全面地对医保费用进行量化管理,确保医保费用合理使用。[方法]通过应用病例分型质量费用管理软件,对某市级医院2008年1~12月份的医保与非医保病例相关指标进行统计学分析与对比。[结果]2008年共收治医保患者21783人次,危重率为69.91%,高于非医保组患者(P﹤0.05);病例优良率为66.97%,低于非医保组(P﹤0.05);医保病例平均人均住院费用为12252元,比非医保病例高2399元。[结论]将“病例分型管理”软件运用到医院医疗保险管理中,有助于规范相关医疗行为,加强和完善医保管理工作。 [Objective] To explore the medical insurance management methods suitable for public hospitals, to guarantee the quality of medical treatment at the same time, to ensure the timely and effective management of the medical insurance costs quantitatively and ensure the rational use of medical insurance expenses. [Methods] Through the application of case-type quality cost management software, the statistical analysis and comparison of relevant indexes of medical insurance and non-medical insurance cases in a city-level hospital from January to December in 2008 were made. [Results] A total of 21 783 medical insurance patients were admitted in 2008, with a critically ill rate of 69.91%, which was higher than that of the non-medical insurance group (P <0.05). The excellent and good cases were 66.97%, lower than the non-medical insurance group (P <0.05) The average per capita hospitalization fee was 12,252 yuan, 2399 yuan higher than non-Medicare cases. [Conclusion] The application of “case classification management ” software to the hospital medical insurance management helps to standardize relevant medical behaviors and strengthen and perfect the medical insurance management.