The calculation of the medical insurance cmi index involves multiple steps such as understanding of basic concepts, data cleaning and standardization, calculation of case weights, and calculation of the final index.
1. Understand the basic concepts of the medical insurance cmi index
The medical insurance cmi index, also known as the Case Mix Index, is a method used to evaluate the complexity of cases and medical treatment in medical institutions. An indicator of the technical difficulty of the service. By calculating the cmi index, it can objectively reflect the type of disease, severity of illness, and the amount of medical resources required for patients treated by medical institutions.
2. Determine the calculation scope and data source
When calculating the medical insurance cmi index, it is necessary to clarify the calculation scope and data source. Usually, the calculation scope includes all inpatient cases in medical institutions, and the data sources are the hospital's medical record system, medical insurance settlement system, etc.
3. Data cleaning and standardization processing
After obtaining the original data, data cleaning and standardization processing need to be performed. This includes removing duplicate, erroneous or unusual data, coding and classifying data, and unifying units of measurement, among other things.
4. Calculate case weight
Case weight is one of the key steps in calculating the cmi index. The weight of each case is determined by assigning values ??to factors such as different disease types and severity of illness. The size of the weight reflects the complexity of the case and the consumption of medical resources.
5. Calculate cmi index
After obtaining the weight of each case, add it up and divide it by the total number of cases to get the cmi index. The calculation formula is: cmi index = Σ (weight of cases)/total number of cases.
6. Interpretation and application of results
The calculated cmi index can be used to evaluate the quality and efficiency of medical services in medical institutions. A higher cmi index usually means that the cases treated by medical institutions are more complex, the medical service technology is more difficult, and more medical resources are required. Medical institutions can adjust and optimize the allocation of medical resources based on the cmi index and improve the level of medical services.
In summary:
The calculation of the medical insurance cmi index involves multiple steps such as understanding of basic concepts, data cleaning and standardization, calculation of case weights, and calculation of the final index. By calculating the cmi index, it can objectively reflect the complexity of cases and the technical difficulty of medical services in medical institutions, and provide an important basis for resource allocation and service quality improvement of medical institutions.
Legal basis:
"Social Insurance Law of the People's Republic of China"
Article 23 stipulates:
Employees They must participate in the basic medical insurance for employees, and the employer and the employee shall jointly pay the basic medical insurance premiums in accordance with national regulations.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexible employment personnel can participate in the basic medical insurance for employees, and individuals must pay for the basic medical insurance in accordance with national regulations. fee.
"Social Insurance Law of the People's Republic of China"
Article 30 stipulates:
The following medical expenses are not included in the payment scope of the basic medical insurance fund:
(1) Should be paid from the work-related injury insurance fund;
(2) Should be borne by a third party;
(3) Should be paid by the company ***Health burden;
(4) Seeking medical treatment abroad.
Medical expenses should be borne by a third party in accordance with the law. If the third party fails to pay or the third party cannot be identified, the basic medical insurance fund shall pay first. After the basic medical insurance fund has paid in advance, it has the right to recover compensation from the third party.