摘要
目的分析病种点数付费方式改革对珠海市三级公立医院的影响。方法访谈改革医院高层管理者、医保科管理人员等15名关键知情人,了解改革中存在的问题;定量分析改革前后医院的运行数据。结果访谈发现,改革中存在医务人员观念转变不够,复合型人才缺乏,临床、医保和信息三方配合不足等问题;主要改革做法为融合医保改革与绩效评价、平衡科室的医保资金分配、加强病种点数管理等。数据分析显示,改革后医院病例组合指数增加0.13,病床使用率总体呈上升趋势,危重病人抢救成功率增加10.4个百分点,平均住院日减少1天,药占比下降10个百分点。结论病种点数付费方式改革对提高医院实力、促进医保高质量发展具有积极作用,需完善医院改革配套机制、复合多元的医保支付方式,加强医保智能审核监控。
Objective To analyze the impact of the reform of the disease point payment method on the operation of a tertiary public hospital in Zhuhai.Methods Fifteen key informants,including senior managers of reformed hospitals and managers of medical insurance departments,were interviewed to understand the problems in the reform and the data of hospital organization operation before and after the reform were quantitatively analyzed.Results The interview found that there were problems in the reform such as insufficient change of medical staff’s concept,lack of composite talents,and insufficient tripartite cooperation among clinical,medical insurance and information.The main reform practices were integrating medical insurance reform and performance evaluation,balancing medical insurance fund allocation of departments,and strengthening the management of patient type points.Data analysis showed that,after the reform,the hospital CMI increased by 0.13,the utilization rate of hospital beds showed an overall upward trend,the success rate of resuscitation of critically ill patients increased by 10.4 percentage points,the average hospitalization day decreased by 1 day,and the medication ratio decreased by 10 percentage points.Conclusion The reform of disease point payment has a positive effect on improving hospital strength and promoting high-quality development of health insurance.It is necessary to improve the supporting mechanism of hospital reform,improve the composite and diversified medical insurance payment methods,and strengthen the intelligent audit and monitoring of medical insurance.
作者
赵炜
梁宝方
周燕
曾艺欣
任娜
甘莉
谢伦
陈江芸
Zhao Wei;Liang Baofang;Zhou Yan;Chen Jiangyun(Zhuhai People’s Hospital/Zhuhai Hospital Affiliated with Jinan University,Zhuhai,Guangdong,519000,China;不详)
出处
《中国医院管理》
北大核心
2022年第7期21-24,共4页
Chinese Hospital Management
基金
广东省省级大学生创新创业训练计划项目(S202112121144)
广东省普通高校哲学社会科学重点实验室项目(2015WSYS0010)
广州市人文社会科学重点研究基地(2021-2023)。
关键词
病种点数付费
三级公立医院
改革
medical service point payment
tertiary public hospital
reform
