Construction of Medical Insurance DRG Refined Supervision and Precise Governance System:Take"Medi-cal Insurance High-speed Railway",Nanjing as An Example
Construction of Medical Insurance DRG Refined Supervision and Precise Governance System:Take"Medi-cal Insurance High-speed Railway",Nanjing as An Example
Taking the reform of DRG payment methods as the background,it discusses how the medical in-surance department uses information technology to achieve refined monitoring and management of medical institu-tions,so as to improve the quality and efficiency of medical services and control the unreasonable growth of medical expenses.The three stages of"precision monitoring-refined supervision-precision governance"of medical insurance DRG based on"refined theory"are proposed;taking Nanjing's"medical insurance high-speed railway"as an example,a DRG refined supervision and governance model framework is constructed,and its analysis is carried out monitoring elements and governance elements,and finally put forward implementation suggestions,including hori-zontal collaboration led by medical insurance,establishing a service and cost evaluation mechanism that combines in-ternal and external services.
关键词
医疗保障/疾病诊断相关分组精细化理论/监管与治理体系/信息化
Key words
healthcare insurance/DRG refined theory/supervision and governance system/informatization
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