在"医疗、医保、医药"协调联动改革背景下，随着以按疾病诊断相关分组(diagnosis related groups，DRG)为主的医保支付方式改革的深入推进，促使医疗机构主动转变管理理念、持续提升精细化管理水平和建立科学的成本管理思路，进而实现高质量发展。为保证DRG付费制度在医疗机构落地实施，在深入分析DRG支付管理要求、实施细则以及结算模式的前提下，医院管理中需要解决的关键问题包括病案入组准确性、合理控制医疗费用、调整诊疗结构。文章结合医院管理实践，从医保DRG付费的制度设计、医院管理策略等方面进行分析与探讨。DRG付费下的医院管理策略重点应从多部门协调配合、医疗服务流程整合与再造、单病种费用标准化管理、强化病案首页能力建设等方面着力，并依托医院信息化建设实现管理闭环。研究结果为各级定点医疗机构应对DRG付费提供了管理建议。
Research Key Technologies of Fine Management in Hospitals Based on Disease Diagnosis Related Groups Payment
Under the reform of medical insurance payment methods mainly based on diagnosis related groups (DRG),hospitals should actively transform their management concepts and improve their level of refined management.Based on understanding the implementation plan and rules of DRG payment,key issues that needed to be solved in hospital management including accuracy of medical record enrollment,reasonable control of medical expenses,and adjustment of diagnosis and treatment structure.In order to ensure the smooth implementation of DRG payment system in medical institutions.This study combines hospital management practices to analyze and explore the system design of medical insurance DRG payment and hospital management strategies.The hospital management strategy should focus on coordinating and cooperating with multiple departments,integrating and reengineering medical service processes,standardizing single disease cost management,strengthening the capacity building of medical record front pages,and relying on hospital information construction to achieve a closed-loop management.The research findings provide management recommendations for designated medical institutions at all levels to cope with DRG payments.
diagnosis related groups paymenthospital managementkey technologytreatment pathwaymedical costsscientific operation
万方数据
维普
