摘要
目的分析医院医保管理中PDCA循环管理模式的应用价值。方法在我院接诊的门诊患者中随机选出2019年1—12月260例患者作为观察组,采取PDCA循环管理模式。2018年1—12月260例患者作为对照组,采取常规性管理。分别对两组患者的总体满意度、门诊次均费用(城镇职工医保每次门诊费用,城乡居民医保每次门诊费用)以及医保报销比例(城镇职工医保报销比例,城乡居民医保报销比例)进行比较。结果PDCA循环医保管理模式后医务人员的医保政策知晓度、患者的满意度提高(P<0.05);医保指标完成情况有所改善。结论在医院医保管理中应用PDCA循环管理模式,可以有效地提升门诊患者总体满意度,控制门诊费用,改善医保完成情况,从而提高医保管理质量,增强医院的经济效益和社会效益。
Objective To analyze the application value of PDCA cycle management model in hospital medical insurance management.Methods The outpatients were randomly selected from the outpatients in our hospital.A total of 260 outpatients admitted from January to December 2019 were randomly selected as the observation group and adopted PDCA cycle management model.A total of 260 outpatients admitted to our hospital from January to December 2018 were selected as the control group for routine management.Overall satisfaction of the two groups,the average outpatient expenses for each group of outpatients(Medical Insurance for urban employee outpatient expenses,Medical Insurance for urban and rural residents each outpatient expenses),and reimbursement ratio(Medical Insurance for urban employee reimbursement ratio(%),Medical Insurance for urban and rural residents reimbursement ratio(%)were compared.Results After the PDCA cycle medical insurance management model,the medical staff’s health insurance policy awareness degree,and the overall satisfaction of outpatients were improved(P<0.05);The completion of medical insurance indicators has improved.Conclusion The application of PDCA cycle management model in the hospital medical insurance management can effectively improve the overall satisfaction of outpatients,control the out-patient cost,and improving the delivery of health care targets.Thus continue to improve medical insurance management,improve its quality,enhances economic and social benefits of the hospital.
作者
牛毅
NIU Yi(Medical Insurance Office,Beijing Stomatological Hospital Capital Medical University,Beijing 100050,China)
出处
《中国卫生标准管理》
2020年第24期18-21,共4页
China Health Standard Management
关键词
医院
PDCA循环管理模式
医疗保险管理
医疗保险基金
满意度
医保报销
hospital
PDCA cycle management model
medical insurance management
medical insurance fund
satisfaction
medical insurance reimbursement
