精细化管理在按病种限额结算费用控制中的应用

摘要

Objective The paper studies the hospital refined management practice in the settlement cost way according to the limiting expenses of diseases. Methods The detailed diagnosis and treatment course of patients with limiting expense settlement was retrospectively analyzed, the hospitalization expenses were checked, the expense control responsibility was implemented by different levels through the information and real-time control method, and the operational situation was giv-en refined analysis thus improving the efficiency of medical insurance funds. Results Since the second half of 2014, the medical insurance quota settlement of staff was given refined management, and the complaints and adverse medical acci-dents caused by quota settlement did not occur during the course of refined management, and the refined cost accounting and medical insurance quota settlement of staff decreased from +22.11% to -1.80%. Conclusion The application value of refined management in the settlement cost control according to the limiting expenses of diseases is high, which can not only ensure the safety of patients, but also obtain a better cost control effect, which is worth great promotion.%目的：该文探讨在按病种限额结算付费方式下的医院精细化管理实践。方法通过回顾分析限额结算患者的详细诊疗过程，核算住院费用，住院过程中应用信息化和实时控制的方法层层落实费用控制责任，对运行情况进行精细化的分析提高医疗保险基金的效用。结果自2014下半年度开始对职工医保限额结算实行精细化管理，期间未出现因为限额结算而导致的投诉、未发生不良医疗事故，精细化成本核算和考核前后职工医保限额结算从超额22.11%下降到-1.80%。结论精细化管理在按病种限额结算费用控制中的应用价值较高，不仅保障了患者安全，同时也取得了较好的控费效果，值得大力推广。