[1]唐志鹏.按病种分值付费模式对医院医保控费管理及精细化管理的影响[J].医学信息,2024,37(14):81-84.[doi:10.3969/j.issn.1006-1959.2024.14.015]
　TANG Zhi-peng.Influence of Diagnosis-intervention Packet on Hospital Medical Insurance Cost Control Management and Refined Management[J].Journal of Medical Information,2024,37(14):81-84.[doi:10.3969/j.issn.1006-1959.2024.14.015]
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按病种分值付费模式对医院医保控费管理及精细化管理的影响()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
37卷
期数:
2024年14期
页码:
81-84
栏目:
卫生管理信息学
出版日期:
2024-07-15

文章信息/Info

Title:
Influence of Diagnosis-intervention Packet on Hospital Medical Insurance Cost Control Management and Refined Management
文章编号:
1006-1959（2024）14-0081-04
作者:
唐志鹏
（天津市环湖医院医保科，天津 300350）
Author(s):
TANG Zhi-peng
(Medical Insurance Department of Tianjin Huanhu Hospital,Tianjin 300350,China)
关键词:
按病种分值付费; 医保控费管理; 精细化管理
Keywords:
Diagnosis-intervention packet; Medical insurance cost control management; Refined management
分类号:
R197.3
DOI:
10.3969/j.issn.1006-1959.2024.14.015
文献标志码:
A
摘要:
目的 研究按病种分值付费模式对医院医保控费管理及精细化管理的影响。方法 收集2022年7月-12月天津市环湖医院实施按病种分值付费模式病例2048例，以及2022年1月-6月未实施按病种分值付费模式病例2050患者，比较不同时间段人均住院费用、住院时间、医疗费用、政策内费用、药费、治疗费及基金统筹支付金额、个人支付金额，并采用双重差分法比较不同时间段人均医疗费用和住院时间效应值及病患重复住院率。结果 2022年7月-12月人均住院费用、住院时间、医疗费用、政策内费用、药费、治疗费及基金统筹支付金额、个人支付金额均低于2022年1月-6月（P＜0.05）；2022年7月-12月人均医疗费用和住院时间差分效应值均低于2022年1月-6月（P＜0.05）；2022年7月-12月病患重复住院率为23.63%，与2022年1月-6月的20.02%比较，差异无统计学意义（P＞0.05）。结论 按病种分值付费模式可促进医院医保控费管理和精细化管理的运行效率，一定程度降低人均医疗费用，缩短人均住院时间，为按病种分值付费模式更加规范、合理提供了一定的条件。
Abstract:
Objective To study the influence of diagnosis-intervention packet on hospital medical insurance cost control management and refined management.Methods From July to December 2022, 2048 cases of diagnosis-intervention packet mode were collected from Tianjin Huanhu Hospital, and 2050 cases of diagnosis-intervention packet mode were not implemented from January to June 2022. The per capita hospitalization expenses, hospitalization time, medical expenses, policy expenses, drug expenses, treatment expenses, fund co-ordination payment amount and individual payment amount were compared in different time periods, and the difference-in-difference method was used to compare the per capita medical expenses and hospitalization time effect values in different time periods and the patient’s repeated hospitalization rate.Results From July to December 2022, the per capita hospitalization expenses, hospitalization time, medical expenses, policy expenses, drug expenses, treatment expenses, fund co-ordination payment amount and individual payment amount were lower than those from January to June 2022 (P<0.05). The difference effect values of per capita medical expenses and hospitalization time from July to December 2022 were lower than those from January to June 2022 (P<0.05). The repeated hospitalization rate of patients from July to December 2022 was 23.63%, which was compared with 20.02% from January to June 2022, the difference was not statistically significant (P>0.05).Conclusion The diagnosis-intervention packet can promote the operation efficiency of hospital medical insurance cost control management and refined management, reduce the per capita medical expenses to a certain extent, shorten the per capita hospitalization time, and provide certain conditions for the diagnosis-intervention packet to be more standardized and reasonable.

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更新日期/Last Update: 1900-01-01