摘要
以按疾病诊断相关分组(DRG)支付方式改革为背景,探讨医保部门如何利用信息技术实现对医疗机构的精细化监测和管理,以提高医疗服务质量和效率,控制医疗费用的不合理增长。提出了以“精细化理论”为基础的医保DRG“精密监测—精细化监管—精准治理”三阶段;以南京“医保高铁”为例,构建DRG精细化监管与治理模型框架,分析其监测要素和治理要素,最后提出了落地建议,包括医保牵头横向协同、建立内外结合的服务与费用评估机制等。
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.
作者
李帅龙
叶雨昕
邢倩
刁仁昌
唐文熙
Li Shuailong;Ye Yuxin;Xing Qian(School of International Pharmaceutical Business,China Pharmaceutical University,Nanjing,Jiangsu,211198,China;不详)
出处
《中国医院管理》
北大核心
2024年第2期6-10,共5页
Chinese Hospital Management
基金
南京市医保研究会重点项目(NJYB2022ZD003)
南京市医保研究会基础项目(NJYB2022JC010)。
