[1]徐莹波,吴志伟.DRG付费下打造医保基金安全生态圈的思考[J].卫生经济研究,2021,38(12):54-56.
　XU Ying-bo,WU Zhi-wei.Thoughts on Creating a Security Ecosystem of Medical Insurance Funds under DRG Payment[J].Journal Press of Health Economics Research,2021,38(12):54-56.
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DRG付费下打造医保基金安全生态圈的思考
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
38
期数:
2021年12期
页码:
54-56
栏目:
地市经验
出版日期:
2021-12-02

文章信息/Info

Title:
Thoughts on Creating a Security Ecosystem of Medical Insurance Funds under DRG Payment
作者:
徐莹波1; 吴志伟1
1.浙江省永康市医疗保障局，浙江 永康 321399
Author(s):
XU Ying-bo;  WU Zhi-wei
Medical Security Bureau of Zhejiang Yongkang, Yongkang Zhejiang 321399, China
关键词:
DRG付费; 预警管控; 驻院巡查代表制; 医保基金安全生态圈; 永康市
Keywords:
DRG payment;  early warning management and control;  resident inspection representative system;  security ecosystem of medical insurance funds;  Yongkang City
分类号:
F840.684
文献标志码:
B
摘要:
浙江省永康市在推进DRG付费改革中，通过强化预算、提高共识、创新预警管控、引入第三方开展“驻院巡查代表制”等措施，遏制了医疗费用的不合理增长，有效提升了医保基金使用绩效。未来将通过建立可操作的监管制度、创新医保基金监管方式、完善医保基金监管系统，继续推进医保基金安全生态圈建设。
Abstract:
In advancing the DRG payment reform in Yongkang City, Zhejiang Province, measures such as strengthening budgets, improving consensus, innovating early warning management and control, and introducing third parties to carry out "resident inspection representative system" have curbed the unreasonable growth of medical expenses, effectively increased the using performance of medical insurance funds, and initially created a security ecosystem of medical insurance funds. In the future, we will continue to promote the construction of the security ecosystem of medical insurance funds by establishing an operational supervision system, innovating the supervision mode of health insurance fund, and improving the supervision system of health insurance fund.

参考文献/References:

[1] 林源.美国医疗保险反欺诈法律制度及其借鉴[J].法商研究，2013（3）：125-135.
[2] 李芬，金春林.以价值为导向的医保支付制度实施路径[J].卫生经济研究,2021，38（1）：10-13.

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更新日期/Last Update: 2021-12-02