摘要
目的研究在智能系统监管的基础上,实现医保精细化管理,以及提升合理用药水平的有效实践。方法将本院2021年-2022年被市医保局判为存在违规问题而拒付的处方或医嘱200例作为研究对象,并将2021年的100例处方或医嘱数据设为对照组,将2022年的100例则作为试验组,在基于智能系统监管条件下,分析两组医保精细化管理实践情况与合理用药水平。结果在对医保进行精细化管理情况下,2022年医院超支比例控制较2021年更优良,差异有统计学意义(P<0.05);相比于对照组,试验组合合理用药水平更高,差异有统计学意义(P<0.05);试验组拒付处方或医嘱数据总有效率明显比对照组更高,差异有统计学意义(P<0.05)。结论医保智能审核平台上线后,医保智能审核方式及规则得到较好改善,可及时统计、分析医院医保拒付问题,有利于及时解决问题,促进医院建立合理有效的用药监管模式,促进临床规范诊疗,提升合理用药水平的同时,提升医保管理效率性、合理性,降低医保拒付率,从而确保医院医保的使用更合理有效,值得推广。
Objective To study effective practice of refined management of medical insurance and improving level of rational drug use based on intelligent system supervision.Methods The paper chose 200 prescriptions or medical orders violated regulations by the Municipal Medical Insurance Bureau from 2021 to 2022 in our hospital as research subjects.100 prescriptions or medical order data from 2021 were included in control group and 100 cases from 2022 in experimental group.Under supervision of intelligent systems,practice of refined medical insurance management and rational medication level in both groups was analyzed.Results Under refined management of medical insurance,proportion of hospital overspending in 2022 was better controlled than 2021,difference was significant(P<0.05).Experimental combination had higher level of rational drug use than control group,difference was statistically significant(P<0.05).Total effective rate of prescriptions denial or medical data in experimental group was significantly higher than control group(P<0.05).Conclusion After launch of medical insurance intelligent review platform,methods and rules of medical insurance intelligent review have been greatly improved,can carry on timely statistics and analysis of hospital medical insurance denial,help solve problems in a timely manner,promote establishment of reasonable and effective drug use supervision models in hospitals,promote clinical standardized diagnosis and treatment,improve level of rational drug use,improve efficiency and rationality of medical insurance management and reduce medical insurance denial rate,and ensure reasonable and effective use of hospital medical insurance,which is worthy of promotion.
作者
谭淑娆
TAN Shurao(Medical Insurance Department,Jiangmen City Wuyi Hospital of Traditional Chinese Medicine,Jiangmen,Guangdong 529020)
出处
《智慧健康》
2023年第19期9-13,共5页
Smart Healthcare
关键词
智能系统监管
医保精细化管理
合理用药水平
实践与研究
Intelligent system supervision
Refined management of medical insurance
Reasonable medication level
Practice and research
