医保门诊信息共享监管应用效果分析.pdfVIP

| MEDICAL I NSURANCE 医疗保险 矗 G恶也?叫: 医保门诊信息共享监管应用效果分析 . 丈尤慧① 乔岭梅② 沈伟彬① 崔 壮③ 吴长矛IJ ① 【关键词】 医保门诊信怠共享监管 【铺 要】 目的:分析医保门诊联网信怠共享监管的应用效果，完善医保管理。 方法: 调取2∞9年-2012年天津市社会保险基金管 理中心和天津市6所三级甲等综合医院数据，对被调医院医保办进行访谈， 将资料整理汇总、对比分析。 结果: 天津市普通门诊和 门诊特殊病就医人数分别地长了117.20%及65.03% ，被调6所医院分别地长了96.1 6%及55.09%。 药品费占医疗费发生额比例被调6 所医院普通门诊和门特病2012年比2011年分别下降了0.50%和12.46%。 结论: 医保门诊信息共享监管能全面监控医保基金的合理使 用， 在遏制患者骗保、医患合谋违规等管理应用中效果明显。 Analysis on appli臼tion e仔éct of the medica l insurance clinic information sharing supervision 1 WEN Guanghui , Q IAO Lingmei , SHEN Weibin , CU I Zhuang , WU Changli 11 Chinese Hospitals. -2014,18(2):48-50 ( Key words ] medical insurance clinic infonnation sharing, supervision ( Abstract ] Ohjectives: To analyze the application effect of the med ical insurance clinic network information sharing supervision and complete medical insurance management. Methods: Data from Tia叮in Social Insurance Fund Management Center and 6 tertiary general hospitals from 2009 to 2012 were collected and in-depth interviews with medical insurance offic...s in 6 selected h嗣pitals were carried out to do a ∞mp盯.ative study. Results: The numbers of hospitalized people in Tianj in general clinics and special d is...ase clinics have increased by 117.20% and 65.20% respectively. The numbers of6 selected hospitals have increased by 96.16% and 55.09% respectively. Compared with the year of2011 , medicine c捕t in general clinics and special disease clinics of the 6 hospitals fell by 0.50% and 12.46% respectively. Conclusions: The medical insurance clinic information sharing supervision completely supervises 由e 怦~nable use of medical insurance fu时， plays positive role in the management ofprohibiting insurance fraud, illegal co