| 摘要: |
| 目的 研究医院在医保总量既定条件下，应该采取怎样的改革措施和管理手段，来实现医保总量资金合理、有效的使用，谋求一种医保服务人次最大化和满意度较高的医疗服务模式。方法 采取代数方法计算各科室总量，将仁济医院2009年和2008年的医保各项具体指标进行比较分析。结果 仁济医院2009年完成医保总量61 549万元，比全年指标累计节余250万元。医保门急诊和住院服务人次与2008年同期相比分别上升7.6%和7.7%，均次费用控制较好。结论 医保总量预付制前提下，医院可以通过加强内部管理、提升内涵质量、调整费用结构、调动医务人员积极性，来实现医保资金的有效使用，最终达到多方共赢的局面。 |
| 关键词: 医保费用 预付制 内涵质量 |
| DOI： |
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| 基金项目: |
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| Taking the Handle of the Reformation of Prepaid Medical Insurance to Improve the Building Content of Hospital |
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| Abstract: |
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Objective
To study, at the condition of limited total amount of medical insurance, which reformation and approach of management can be adopted to achieve the efficiency and optimization of allocation of total medical insurance, and to establish a model maximizing number of service and high level of satisfaction. Methods By adopting algebra calculation method to get the total amount of each department, every single indicator of the completion of medical insurance of Renji Hospital in 2008 and 2009 is comparatively analyzed. Results In 2009，we actually spent 615.49 million yuan of the medical insurance fund, and got a balance about 2.5 million yuan. Outpatient and emergency service person trip, and hospital service person trip of medical insurance respectively increased 7.6% and 7.7% during the same period in 2008. We got a better control of average level of medical insurance expense. Conclusion At the condition of limited total amount of medical insurance, hospital can achieve the efficiency use of total medical insurance，and finally get the win-win situation by strengthening internal management, raising quality content, adjusting expense structure and manoeuvring the motivation of personnel. |
| Key words: medical insurance,prepaid system,connotative quality |
