医保费用监控平台实施效果评价

摘要

目前我国大部分地区的居民医保体系都采用总额预付制的费用支付方式,而这种方式会因医保种类繁多,数据庞大,政策变更频繁等因素给医保控费带来困难.现广州军区广州总医院自主设计了一款医保费用监控平台软件,采取事前事中监测,在院病人医保费用干预,科室、临床医生、特殊病种医保费用实时监控等策略,多维度协助医保控费管理.从平台实施前后近三年,统计分析相关数据指标来看,医保费用的上涨趋势得到了一定控制,次均费用增长速度下降,医保控费效果初步显现.%At present, the medical insurance system in most areas of China adopts the method of total prepayment, and due to a wide range of medical insurance, huge data, frequent changes in policy and other factors, the application of total repayment brings much difficulties to medical insurance cost control. Now our hospital independently designed a Medicare cost control platform, taking detection in advance, intervening in hospital patient care departments, clinicians, health care costs and other special disease detection, with a view to assisting medical insurance cost control through multi dimension. From the implementation experience of the platform for nearly three years, statistical analysis of relevant data indicators, health insurance costs rising trend has been under control in certain degree and the average cost growth rate decreased; also, the effect of the medical insurance control fee is Initial appearance. But further improvement of the platform is still needed to achieve better health care management services.