摘要
目的探讨在医疗质量和医疗费用博弈中医院医保管理要点。方法医院医保管理部门作为定点医院医保工作的管理者和医疗保险政策的推行者,通过与医疗保险机构以及医院临床科室的协商和配合,在积极探索合理的医保政策的同时严格监督医保政策在医院执行情况。结果明确了建立合理的沟通机制和谈判机制、做好临床科室宣传工作等医院医保管理要点,有助于提高管理效率,有益于保证医疗质量和控制医疗费用。结论医保管理在医院管理中的重要地位逐步彰显,医院医保管理部门必须狠抓管理要点,充分发挥医保科的职能作用,有效促进医、保、患的和谐发展。
Objective To explore the main points of health care management in hospital in regard to the game benefit of medical care quality versus medical care costs. Methods As an administration of medical insurance and performer of the insur ance policy in a hospital which supervises and carries out policy of this work-should strictly inspect the practice of the policy through consultation and cooperation with medical insurance agents and clinical departments. Results Aware of the mechanism of crea- ting rational communication and negotiation, good at main points of medical insurance management are conducive to promotion of administrative efficiency and guarantee of medical care quality and control of medical costs. Conclusion The importance of medi cal insurance management in hospital gradually manifests, the departments concerned must pay close attention to this aspect and thoroughly develop functional authority of the department of medical insurance and effectively promote harmony development among medical care, medical insurance and patients.
出处
《齐鲁医学杂志》
2012年第6期551-552,554,共3页
Medical Journal of Qilu
