摘要
目的调查临床医生对社会医疗保险(简称医保)病人病种分类的准确性,为社会医疗保险的良好运作、维护医院和医保机构双方的合法权益提供参考依据。方法抽取某院2个月的医保住院病例,对临床医生分类的普通病种和特殊病种进行一一核查,记录分类错误的病例。结果在1151个医保病例当中,共有32个特殊病种的病例被错分为普通病种,错误率为3.4%,有7个普通病种的病例被错分为特殊病种,错误率为3.2%。结论临床医生应当熟练区分普通病种和特殊病种,加强国际疾病分类知识的学习,避免分错病种,并建议在上报病种分类前,增加病案管理人员的审核,以减少差错,维护医院和医保机构双方的合法权益。
Objective To survey the veracity of disease classification of insurance by the doctors,so as to provide references to make the insurance system run very well, and maintain the rights and interests of both the hospitals and the medical insurance agents. Methods All the patients who attended medical insurance within two months in our hospital were selected, every ordinary disease and special disease classification of medical insurance which made by the doctors were checked over. Results Among 1151 cases, there were 33 cases of special disease were classified as ordinary disease mistakenly （error rate was 3.4 percent）, while 7 cases of ordinary disease were classified as special disease（error rate was 3.2 percent）. Condusion The doctors should know how to distinguish the ordinary disease and special disease expertly, and learn more about tb.e International Classification of Disease, to avoid classifying a disease mistakenly. It is suggested that the classification of diseases should be looked through by the medical record managers before submitted, so as to reduce the mistakes, and maintain the rights and interests of both the hospitals and the medical insurance agents.
出处
《中国病案》
2006年第2期4-5,共2页
Chinese Medical Record
关键词
社会医疗保险
病种
分类
medical insurance
Disease type
Classify
