[1]束嘉俊,黄 晖,陈 怡,等.基于医保患三方视角的按病种分值付费SWOT分析[J].卫生经济研究,2022,39(1):36-39.
 SHU Jia-jun,HUANG Hui,CHEN Yi,et al.SWOT Analysis of Payment by Disease Score Based on Perspectives of Hospitals, Medical Insurance, and Patients[J].Journal Press of Health Economics Research,2022,39(1):36-39.
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基于医保患三方视角的按病种分值付费SWOT分析
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
39
期数:
2022年1期
页码:
36-39
栏目:
筹资与支付
出版日期:
2022-01-07

文章信息/Info

Title:
SWOT Analysis of Payment by Disease Score Based on Perspectives of Hospitals, Medical Insurance, and Patients
作者:
束嘉俊1黄 晖1陈 怡1徐 珏1
1.上海市浦东新区人力资源和社会保障局(上海市浦东新区医疗保障局),上海201204
Author(s):
SHU Jia-jun HUANG Hui CHEN Yi XU Jue
Shanghai Pudong New Area Human Resources and Social Security Bureau(Shanghai Pudong New Area Medical Security Bureau), Shanghai 201204, China
关键词:
按病种分值付费医保支付方式SWOT分析
Keywords:
payment by disease score medical insurance payment method SWOT analysis
分类号:
R197
文献标志码:
A
摘要:
将医院、医保、患者引入按病种分值付费的SWOT分析中,剖析按病种分值付费改革的优势、劣势、机遇和挑战,在此基础上,从医院和医保的管理角度提出建议:提高病案首页填写质量、提升数据分析和信息整合能力、创新临床科室绩效考核方案、健全医保监督管理体系、促进医保和医疗紧密互动。
Abstract:
Introduce hospitals, medical insurance, and patients into the SWOT analysis of payment by disease score, analyze the advantages, disadvantages, opportunities and challenges of the payment by disease score reform, and on this basis, proposes suggestions from the perspective of hospital and medical insurance management: improve the fill-in quality of the front page of medical records, improve the ability of data analysis and information integration, innovate the performance evaluation scheme of clinical departments, improve the medical insurance supervision and management system, and promote the close interaction between medical insurance and medical treatment.

参考文献/References:

[1] 国家医疗保障局办公室.关于印发国家医疗保障按病种分值付费(DIP)技术规范和DIP病种目录库(1.0版)的通知(医保办发〔2020〕50号)[Z].2020.
[2] 张映钰,乐煦,曾茜.广州市基于大数据的病种分值付费实施路径与成效[J].中国医疗保险,2020(9):47-51.
[3] 周尚成.我国社会医疗保险谈判机制研究[D].华中科技大学,2011.
[4] 李菊红,周林玉,陈灵峰.CMI在促进医疗服务能力提升的作用研究[J].医院管理论坛,2020,37(6):30-32,14.
[5] 秦环龙,吴丹枫,李烨楠.DRGs+DIP助推公立医院高质量发展[J].中国医院院长,2020,16(21):78-80.
[6] 赵斌,张昕煜.诊断相关分组与病种分值结算的比较研究[J]. 中国社会保障,2019(2):81-83.
[7] 王碧艳.医保支付方式改革下病种点数法对我国分级诊疗的影响[J].中国医院管理,2020,40(2):18-20.
[8] 贾洪波,段文琦.基本医保按病种分值付费的实践探讨[J].卫生经济研究,2018(5):57-59.
[9] 黄雨萌,钟正东,曾理,等.基于博弈论的德国点数法下的医师行为分析及启示[J].中华医院管理杂志,2020,36(8):698-701.
[10] 许速,谢桦,崔欣,等.基于大数据的病种分值付费的原理与方法[J].中国医疗保险,2020(9):23-28.
[11] 陈曼莉,赵斌,杨希.按病种分值付费的技术要点分析[J].中国卫生经济,2019,38(4):27-31.
[12] 谭华珍,于磊,周爱莲,等.按病种分值付费影响住院医保费用结算差额的因素分析[J].中国病案,2020,21(10):58-62.
[13] 许慧娜,卢介珍,吴玉连,等.病案首页信息填写缺陷分析与建议[J].中国卫生标准管理,2018,9(22):21-23.
[14] 张中花,章浩然.基于DRG的安徽某大型三甲医院病案首页质量改进研究 [J].卫生经济研究,2020(3):29-31.
[15] 李忠民,谢丽敏,杜育雄,等.湖南省109家医院病案编码员现状调查[J].中国病案,2019,20(4):8-10.
[16] 厦门市医疗保障局.厦门市总额预算下点数法支付方式改革经验与成效[J].中国医疗保险,2020(10):45-49.
[17] 郑贵秀.医院绩效分配改革的实践与思考[J].中国卫生产业,2016,13(34):157-159.
[18] 黄华波.浅议医保基金监管的体制性特点、机制性问题与长效机制建设[J].中国医疗保险,2020(4):20-24.
[19] 邓添薪,张帆,满丽芳,等.专科编码员工作模式的探讨[J].中国病案,2017,18(6):14-16.
[20] 翁志雄,余志金,林燕峰,等.基于电子病历的临床诊断编码分值库的建立和应用研究[J].中国当代医药,2020,27(19):196-199.
[21] 王樱.总额控制下按病种分值结算体系建设实践与思考——基于淮安市15年经验总结与回顾[J].中国医疗保险,2018(12):16-19.
[22] 王忠平.创新医保治理推进基金全流程闭环监管[J].中国医疗保险,2020(12):1-4.
[23] 汪欢,李锦汤,彭秀萍.广东推进按病种分值付费改革的做法和成效[J].中国医疗保险,2019(9):50-52.
[24] 顾昕.医保支付改革中国探索的历史回顾与反思——以按疾病诊断组(DRGs)支付为案例[J].中国医院院长,2020(12):65-75.

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更新日期/Last Update: 2022-01-07