基于医院医保智能化管控下的某省级医院门诊医保患者药品拒付费用简析及改进措施

摘要

目的 基于医院医保智能化管控,分析门诊医保患者药品拒付原因及改进措施.方法 利用EXCEL软件整理2014-2015年某省级医院门诊药品数据.结果 在医院医保智能管控不断完善下,2015年拒付费用较2014年降低,但仍存在拒付的现象,拒付原因主要有"药品超量"、"重复用药"、"阶梯用药"等.结论 通过全流程的医保智能化管控,充分发挥医保管理机构与临床的沟通桥梁作用,2015年该院门诊药品的拒付较去年同期有了明显的改善.%Objective To analysis the reason and improvement measure of Drug dishonor in outpatient based on the intelligent control of medical insurance.Methods Drug data of the outpatient in a provincial hospital from 2014 to 2015 were sorted out by EXCEL.Results Under the improving intelligent control of health insurance,drug dishonor declined in 2015 compared with 2014,but the phenomenon still exist.The main reasons were "excessive drugs","repeated medication","ladder medication" and so on.Conclusion Drug dishonor declined in 2015 compared with the same period in 2014 through the intelligent management of medical insurance and communication between health care management organization and hospital.