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目的:分析医保投诉问题,从中查找医院管理因素的影响,强化医院职能和绩效考评办法,确保医疗工作正常秩序。方法:对照分析2011年及2012年度管理前后医保投诉问题的指标变化。结果:2012年度比2011年度住院患者增加了5223人,投诉总人数减少了111人次,下降了79.86%;门诊刷卡增加393726人次,投诉减少227人次,下降了67.36%,很多具体问题得到了控制。结论:医保投诉是医保管理过程中缺欠问题,主要与医院管理因素有直接关联,完善医院管理至关重要。
OBJECTIVE: To analyze the problem of medical insurance complaints, look for the impact of hospital management factors, strengthen the hospital functions and performance evaluation measures to ensure the normal order of medical work. Methods: Comparative analysis of 2011 and 2012 before and after management changes in medical insurance complaints. Results: In 2012, the number of hospitalized patients increased by 5223 compared with 2011, the total number of complaints decreased by 111 and decreased by 79.86%; the number of outpatient credit card swaps increased by 393726; the number of complaints decreased by 227 and decreased by 67.36%. Many specific problems were under control. Conclusion: Medical Insurance Complaints is a deficiency in medical insurance management process, which is directly related to hospital management factors. Improving hospital management is of utmost importance.