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医保智能监管体系在医院门诊特定病种管理中的应用

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随着医保体制的不断完善,医院要想可持续发展,需要建立医保智能监管体系,加强医院门诊特定病种管理,实现医保管理智能化、规范化,实现全程实时监管。文章首先概述医保智能监管体系在医院门诊特定病种管理中的应用背景,探讨了医保智能监管体系在医院门诊特定病种管理中应用存在的问题,并分析了医保智能监管体系在医院门诊特定病种管理中的应用发展对策:继续做好医保控费管理与决策管理、建立健全特定病种付费监管体系、建立医院门诊特定病种智能评价与审核系统、建立健全特定病种的资金管理制度。
The application of intelligent medical insurance supervision system in the management of specific out-patient diseases in hospitals
As the medical insurance system continually evolves,the sustainable development of hospitals necessitates the establishment of an intelligent medical supervision system.With this system,hospitals can strengthen the management of specific outpatient diseases,achieve intelligent,standardized medical insurance management,and enable real-time supervision throughout the entire process.This article first outlines the background for applying the intelligent medical insurance supervision system in the management of specific outpatient diseases.It then delves into the problems in the application of this system and proposes strategies for solving the problem.These strategies include continuation of effective medical insurance cost control and decision-making management,improvement of a payment supervision system for specific diseases,establishment of an intelligent evaluation and review system for specific outpatient diseases,and development of a financial management system for specific diseases.

Intelligent medical insurance supervision systemHospitalsOutpatient specific disease managementPay-ment supervisionFinancial management

吴杰

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天津市滨海新区中医医院 天津 300453

医保智能监管体系 医院 门诊特定病种管理 付费监管 资金管理

2024

现代医院
广东省医院协会

现代医院

影响因子:1.332
ISSN:1671-332X
年,卷(期):2024.24(2)
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