摘要
在医保支付方式改革持续深化的背景下,按疾病诊断相关分组付费制度逐步成为公立医院运行管理的重要基础,推动医院从粗放型增长向精细化运营转型。本文聚焦医保DRG结算模式下公立医院面临的运营难点,深入剖析成本核算体系缺失、病案首页与编码质量偏低以及绩效薪酬机制滞后等问题所引发的资源配置失衡与管理效能下降现象,并在此基础上提出融合临床路径与成本核算的精细运营管理路径,构建病案首页标准化与DRG编码质量控制体系,优化绩效分配指标与资源激励机制,旨在为提升公立医院在DRG制度下的应对能力与内生动力提供理论依据与路径参考,促进医院实现成本可控、质量可衡、效率可评的系统性运营目标。
Against the backdrop of the continuous deepening of the reform of medical insurance payment methods,the grouping payment system based on disease diagnosis has gradually become an important foundation for the operation and management of public hospitals,promoting the transformation of hospitals from extensive growth to refined operation.This article focuses on the operational difficulties faced by public hospitals under the DRG settlement model of medical insurance.It deeply analyzes the imbalance of resource allocation and the decline in management efficiency caused by the lack of cost accounting system,low quality of medical record homepage and coding,and lagging performance compensation mechanism.Based on this,it proposes a refined operational management path that integrates clinical pathway and cost accounting,constructs a standardized medical record homepage and DRG coding quality control system,optimizes performance allocation indicators and resource incentive mechanisms,aiming to provide theoretical basis and path reference for improving the response ability and endogenous motivation of public hospitals under the DRG system,and promote hospitals to achieve systematic operational goals of controllable costs,measurable quality,and assessable efficiency.
作者
赵露
Lu Zhao(Taizhou Municipal Hospital,Taizhou,Zhejiang 318000)
出处
《现代管理论坛》
2025年第4期22-24,共3页
Modern Management Forum
关键词
医保DRG结算
公立医院
运营
medical insurance DRG settlement
public hospitals
operation
