1. Medical insurance work situation report
I. Attaches great importance to strengthening leadership, improve the responsibility system of medical insurance management
After receiving the notice requirements, I immediately set up a main leader as the leader, to the leaders in charge of the deputy leader of the self-checking leading group, against the relevant standards, to find the shortcomings, and actively The first step is to make sure that you have the best possible results. We know that basic medical care is an important part of the social security system, and deepening the policy of basic medical insurance system is an inevitable requirement for the development of socialist market economy, and an important measure to protect the basic medical care of the employees and improve their health. Our hospital has always attached great importance to the work of medical insurance, set up a special management team, improve the management system, held many special meetings for research and deployment, and regularly train physicians in medical insurance. Medical insurance work at the beginning of the year there is a plan to regularly summarize the work of medical insurance, analysis of the medical care of insured patients and the cost of the situation.
Second, standardize the management, to achieve the standardization of health insurance services, institutionalization, standardization
Over the past few years, in the Municipal Bureau of Labor and the Municipal Health Insurance Office of the correct leadership and guidance, the establishment of sound rules and regulations, such as the basic medical insurance referral management system, hospitalization process, medical insurance system, charging billing management system, outpatient management system. Setting up the "Basic Medical Insurance Policy Publicity Column" and "Complaint Box"; compiling and printing basic medical insurance publicity materials; publicizing the telephone number for consultation and complaints xxxx; enthusiastically providing consultation services for the insured and properly handling the complaints of the insured patients. In the hospitals, the medical insurance process is announced in a prominent position, making it convenient for insured patients to seek medical treatment and purchase medicines; special windows are set up for the registration and settlement of medical insurance patients. Simplify the process and provide convenient and high-quality medical services. Strict identification is carried out when insured employees are hospitalized, so as to eliminate the phenomenon of impersonation and hospitalization, and to stop hospitalization in the name of the patient and decomposition of hospitalization. The company strictly controls the standards of patient admission, discharge and admission to guardianship wards, implements the principle of treating patients according to their illnesses, and realizes reasonable examination, treatment and medication; there is no falsification or alteration of medical records. Actively cooperate with the medical insurance agency to supervise and audit the diagnosis and treatment process and medical expenses, and provide timely access to medical files and related information. The company strictly enforces the fee standards set by the relevant departments, and does not charge for its own programs or raise the fee standards.
Strengthen the medical insurance policy propaganda, the department as a unit of regular organization to study the "xx city employees medical insurance system compilation", "Shandong Province, the basic medical insurance class B drug payment directory" and other documents, so that each health care personnel more familiar with the directory, to become the propagandist of the medical insurance policy, the explainer, the implementer. The hospital set up a special person to outpatient and hospitalized patients to implement the telephone return visit, the return visit rate of 81.4%, 98% satisfaction rate with the quality of service, by the majority of participants in the praise of the people.
Third, strengthen the management of the insured to provide quality assurance
First, the strict implementation of diagnosis and treatment and care routines and technical procedures. The first physician is responsible for the implementation of the system, the third-level physician room system, the handover system, difficult, critical, death case discussion system, preoperative discussion system, medical record writing system, consultation system, surgical classification management system, technical access system and other core medical systems.
Secondly, on the basis of strengthening the implementation of the core system, focusing on the improvement of medical quality and continuous improvement. The company's quality management system, assessment and evaluation system and incentive and constraint mechanisms are generally improved, and the implementation of hospitals, departments and groups of three-level medical quality management responsibility system, the medical quality management objectives of the cascade decomposition, the responsibility of the person, the inspection and supervision of the gateway to the front, in-depth to the clinical front line to timely detection and resolution of medical work in the problems and hidden dangers. Standardize the processes of early shift handover, director's room check and case discussion. The prescribing right of physicians has been regulated again, and general prescribing right, medical insurance prescribing right, anesthesia prescribing right, and blood transfusion prescribing right have been granted respectively by the examination and test. In order to strengthen the risk control of surgical safety, seriously organized the surgical qualification access assessment examination, the theoretical examination and surgical observation of the participating surgical personnel.
Thirdly, the staff familiarize themselves with the core medical system and strictly implement it in the actual clinical work. Actively learn advanced medical knowledge, improve their professional and technical level, improve the quality of medical care, and serve patients well, while strengthening the humanities knowledge and etiquette knowledge of learning and training, and enhance their communication skills.
Fourth, the medical documents as an important part of the control of medical quality and prevention of medical disputes to grasp. The hospitalized medical records are scored, and the chief of the department reviews the initial evaluation, and the hospital quality control is reviewed again. At the same time actively carry out medical record quality inspection and evaluation activities, the quality and operation of medical records have been effectively monitored, the quality of medical care has improved significantly.
Fifth, strengthen the safety awareness, the doctor-patient relationship is becoming more harmonious. We continue to strengthen the medical safety education, improve the awareness of quality responsibility, standardize medical operation procedures, establish and improve the doctor-patient communication system, take a variety of ways to strengthen the communication with the patient, patiently and carefully to the patient to account for or explain the condition. We are prudent in preoperative, precise in intraoperative and strict in postoperative. Further optimize the service process to facilitate the patient's access to medical care.
By adjusting the layout of the department, increase the service window, simplify the medical links, shorten the waiting time of patients. The outpatient hall set up a medical consulting desk, equipped with drinking water, telephone, wheelchair and other service facilities. Set up outpatient general service desk to provide patients with information guidance and medical services, and timely solution of various difficulties encountered by patients during consultation. We have implemented the system of medical guide service, accompanying service and first-visit responsibility, standardized service language, strengthened the training of nursing etiquette, and eliminated the phenomena of rawness, coldness, hardness, pushing and pushing. Strengthening the privacy of gynecological outpatient clinics, rationally arranging patients' consultation, implementing one doctor, one patient, one consultation room, fully protecting patients' privacy, and making the diagnosis and treatment activities more humanized and comfortable. Attaching importance to detailed services, we give out free cold drinks and hot drinks twice a day to the companions who come to the outpatient clinic, and give out free bread to the patients and companions who do the treatment during the lunch time. For many years, we have been giving out free millet rice to hospitalized patients. We are enthusiastic in patient care service, careful in nursing, elaborate in operation, and patient in answering questions. The postnatal visiting team composed of experienced obstetrics and pediatrics nursing experts conducts health promotion and guidance for discharged mothers and newborns, which is highly praised by mothers and their families. Through a series of heartfelt services, the customer service department in the regular patient satisfaction survey, patient satisfaction has been more than 98%.
Fourth, strengthen the hospital management, standardize the hospitalization procedures and charges settlement
In order to strengthen the standardized management of health insurance work, so that the health insurance policy has been fully implemented, according to the requirements of the municipal health insurance department, the wards adopted the health insurance patients special green bedside card, medical records stamped with the special seal of health insurance. The doctors in charge of the wards all provide treatment according to the illness, reasonable examination and reasonable medication. Strengthen the quality management of medical records, strictly implement the first physician responsibility system, standardize the clinical use of medication, the treating physician should be based on clinical needs and health insurance policy, consciously use safe and effective, reasonably priced drugs in the "Drug List". If it is necessary to use self-financed drugs, [special] drugs, "Class B" drugs, medical materials and related self-financed items outside the Drug List due to the condition of the patient, the treating physician shall explain the reasons to the insured and fill in the "Informed Consent", which shall be attached with the signature of the patient or his/her family members after they agree to sign it. The patient or his family agreed to sign the attached to the hospitalization medical records, the cost of services outside the directory accounted for the proportion of the total cost of control in less than 15%.
V. Strict implementation of the provincial and municipal price departments of the charges
Medical costs are another focus of attention for insured patients. The hospital insists on the cost list system, and the daily cost is sent to the patient, so that the patient can sign before transferring to the charge office, so that the insured can consume in a clear way.
Sixth, the maintenance and management of the system
The hospital attaches importance to the maintenance and management of the insurance information management system, timely elimination of obstacles to the hospital's information management system to ensure that the system operates normally, in accordance with the requirements of the municipal health insurance office of the computer technology special managers are responsible for the requirements of the special computer for health insurance strictly in accordance with the provisions of the special machine dedicated to the problems in a timely manner to contact with the medical insurance office, can not be due to the procedures of the medical expenses can not be settled because of problems. Problems occur and lead to medical expenses can not be settled problems occur, to ensure that participants in a timely and rapid settlement.
We always adhere to the patient-centered, quality-centered, wholeheartedly for the patient service as a starting point, and strive to do the standardization of the establishment of rules and regulations, the service concept of humane, standardized quality of medical care, to correct the practice of conscientiousness, and actively provide participants with high-quality, efficient, inexpensive medical care and a warm medical environment, by the majority of the participants of the commendation, and received a good social and economic benefits. The company has been praised by the majority of participants, and has received good social and economic benefits.
After strict self-examination against the xx city fixed-point medical institutions "target standardized management assessment standards" and other documents, our hospital is in line with the setup and requirements of the medical insurance fixed-point medical institutions.
2. Medical insurance work report
In accordance with the "Luannan County Human Resources and Social Security Bureau on the forwarding of the Tang Renminsha Office No. 20xx21 document "two fixed-point" units of the management of the notification" and other documents, by the hospital relevant staff efforts. Through the efforts of the relevant staff of the hospital, the insured persons who visited the hospital were comprehensively sorted out, and no cost overruns, borrowing cards to see patients, over-scope inspections, listed hospitalization, exchanging drugs for medicines, and substituting medicines with goods were found, which to a certain extent maintains the safe operation of the medical insurance fund. Now the self-inspection work as follows:
First, the basic management of medical insurance:
1, our hospital set up a basic medical insurance management team composed of leaders and relevant personnel, specifically responsible for the daily management of basic medical insurance.
2, the basic medical insurance system is sound, the relevant medical insurance management information according to the standard management archives.
3. The medical insurance management team regularly organizes personnel to analyze the use of various medical expenses of the insured, and if any problem is found, it will be solved in time. From time to time, it will conduct random checks on the management of medical insurance, and if any violation occurs, it will be corrected in time and corrected immediately.
4, the medical insurance management team actively cooperate with the county social security bureau of medical services prices and drug costs of supervision, audit, timely provision of medical files and related information need to access.
Second, the medical insurance service management:
1, Tichang quality service, convenient for the insured to seek medical treatment.
2, the drugs, diagnostic and treatment items and medical services and facilities charges clearly marked prices, and provide an itemized list of costs, and resolutely put an end to the drugs for drugs, goods in lieu of drugs and other illegal acts occur.
3, the identity verification of patients, and resolutely put an end to the phenomenon of impersonation and hospitalization and other phenomena.
4. We ask for the consent of the insured in advance and sign for the medicines and treatment items that are not included in the catalog and which are required to be used by the insured.
5. There is no problem with the quality of medicines after inspection by the drug supervision department.
Third, the medical insurance business management:
1, the strict implementation of the basic medical insurance drug management regulations, the strict implementation of medical insurance drug approval system.
2, to achieve the rate of drug preparation according to the requirements of the basic medical insurance catalog.
3. Checking outpatient prescriptions, discharging medical records, and checking and dispensing of medicines are all carried out in accordance with the regulations.
4. Strictly implement the basic medical insurance treatment program management regulations.
5, the strict implementation of basic medical insurance service facilities management regulations.
Fourth, the medical insurance information management:
1, the hospital information management system can meet the daily needs of the medical insurance work, in the daily maintenance of the system is also more perfect, and can report and actively troubleshoot the medical insurance information system in a timely manner, to ensure the normal operation of the system.
2, on the health insurance window staff skilled in operating skills, health insurance policy learning actively.
3, health insurance data security and integrity.
V. Health insurance cost control:
1. Strict implementation of medical fee standards and health insurance limit regulations.
2. Strictly control the admission and discharge standards, and did not find that participants who do not meet the conditions for hospitalization were admitted to hospital or intentionally delayed discharge, over the scope of the examination and so on.
3, the monthly medical insurance fee statement on time to review, timely settlement of fees.
Sixth, health insurance policy propaganda:
1, regular and active organization of medical staff to learn health insurance policy, timely communication and implementation of the relevant health insurance regulations.
2, take various forms of publicity and education, such as setting up publicity columns, distribution of publicity materials.
After further self-examination and rectification of our hospital's health insurance work, so that our hospital's health insurance work is more scientific and reasonable, so that our hospital's health insurance management personnel and all medical staff to improve their own quality of business, strengthen the sense of responsibility, and prevent the loss of health insurance funds bad, in the social security bureau of the support and guidance, the hospital's health care work to do a better job.
3. Medical insurance work report
20xx year, our hospital strictly implement the higher level of urban workers medical insurance and urban and rural residents medical insurance policy and requirements, at all levels of leadership, the guidance and support of the relevant departments, in the hospital staff *** with the efforts of the work of the health care work, the overall operation of normal, there is no borrowing card. The overall operation is normal, there is no borrowing card to see and over the scope of the examination, decomposition of hospitalization, etc., to maintain the fund 's safe operation. In accordance with the spirit of the document Wenrenshe word [20xx] 276, we organized the hospital management personnel of the 20xx annual health insurance work carried out self-inspection, against the content of the annual inspection of the serious examination, and actively rectify, now will be self-inspection report is as follows:
First, to improve the understanding of the importance of the work of medical insurance
First of all, our hospital set up by the president of the Liang for the leader, the competent vice-president of the vice president for the deputy leader, the director of the department as a member of the medical insurance work of the hospital, the director of the medical department, the director of the medical insurance department as a member of the medical insurance work of the hospital. The director of each department as a member of the medical insurance work leadership group, comprehensively strengthen the leadership of medical insurance work, a clear division of labor responsibility to a person, from the system to ensure the implementation of the objectives and tasks of the medical insurance work. Secondly, all staff members are organized to study the relevant documents carefully. And in accordance with the requirements of the documents, in view of the actual work of the hospital, to find gaps, and actively rectify, medical insurance as a major event. Actively cooperate with the medical insurance department to strictly check the non-compliant treatment items and drugs that should not be used, and do not step beyond the minefield. Resolutely put an end to the occurrence of fraudulent malicious arbitrage health insurance fund violations, to create a brand of integrity health insurance, strengthen self-discipline management, establish a good image of health insurance designated hospitals.
Second, from the system to strengthen the management of health insurance
To ensure that the system is in place, the hospital sound health insurance management system, combined with the actual work of the hospital, focusing on concentrating on the higher level of arrangements for the work of the health insurance target tasks. The hospital has formulated regulations on further strengthening the management of medical insurance work and measures for rewards and punishments, as well as stipulating the duties of personnel in various positions. The basic medical insurance system is sound, and the relevant medical insurance management information is complete and filed in accordance with standardized management. We carefully and timely complete all kinds of paperwork, write medical records on time, fill in relevant information, and upload real medical insurance information to the medical insurance department in a timely manner. Regularly organize staff to analyze the use of various medical expenses of the medical insurance beneficiaries, such as the discovery of problems in a timely manner to solve.
Third, from the practice of real medical insurance work management
Combined with the actual work of the hospital, the strict implementation of basic medical insurance drug management regulations. The company's products and services have been widely used in the medical field, and have been used for many years in the medical field, including the medical industry. All medicines, diagnostic and treatment items and medical service charges are clearly marked, and a detailed list of costs is provided. The daily cost list is sent to the patient for signature before it is forwarded to the charging office, so that the insured person can consume in a clear and unambiguous manner. And repeatedly emphasize to the medical staff to implement the identification of medical personnel to eliminate the phenomenon of impersonation. It is also required to obtain the consent of the insured and sign an informed consent form in advance for the use of medicines and treatment items not included in the catalog. At the same time, it strictly implements the system of responsibility for the first consultation, and there is no phenomenon of shirking patients. In terms of hospitalization, there is no phenomenon of hanging up beds, no decomposition of inpatient treatment, and no excessive examination, duplication of examination or excessive medical treatment. We strictly abide by the clinical and nursing treatment procedures, and strictly implement the clinical medication routine and the principle of combined medication. In terms of finance and settlement, the company earnestly implements the charges of the price department of Shengshi City, and there is no indiscriminate charging behavior, and there is no phenomenon of including medical expenses that do not belong to the responsibility of basic medical insurance in the scope of payment of medical insurance.
Fourth, strengthen the management of the insured to provide quality assurance
First, the strict implementation of diagnosis and treatment and care routine and technical operation procedures.
The second is to strengthen the implementation of the core system, focusing on the improvement of medical quality and continuous improvement.
Third, the staff familiar with the core medical system, and in the actual clinical work of strict implementation.
Fourth, the medical documents as an important part of the control of medical quality and prevention of medical disputes to grasp.
V. Maintenance and management of the system
The information management system can meet the needs of the health insurance work, the daily maintenance system is better, the introduction of new policies or adjustments to the policy in a timely manner to modify the timely report and actively troubleshoot the health insurance information system to ensure that the system's normal operation. The staff at the window of the health insurance system have been strengthened to learn health insurance policies and enhance their operational skills. Information system health insurance data security and integrity, and health insurance xx network services regularly implement the check and kill the virus. Regular and active organization of medical staff to learn health insurance policy, timely communication and implementation of the relevant health insurance regulations, and at any time to grasp the degree of understanding of the medical staff of the health insurance management policies.
Sixth, there are problems and reasons for analysis
Through self-examination found that our hospital medical insurance work has made remarkable achievements, but there are still some gaps from the higher requirements, such as the relevant groundwork, ideological understanding, the business level is still to be further strengthened and consolidated.
(a) The relevant supervisory departments are not strict enough in checking the work of the medical insurance.
(b) some staff thought on the health insurance work is not important, business on the health insurance policy learning is not thorough, did not grasp the entry point of the health insurance work, do not know what to do, which should not be done, which to do in a timely manner.
(C) In the process of patient visits, some medical staff do not fully grasp the process of health insurance.
VII, the next step
In the future, our hospital will be more strict implementation of health insurance policies and regulations, consciously accept the supervision and guidance of the health insurance department. And put forward corrective measures:
(a) to strengthen the medical staff of medical insurance policy, documents, knowledge of the normative study, improve the ideological understanding, to eliminate paralysis.
(b) the implementation of the responsibility system, clear division of leadership and medical insurance management personnel work responsibilities. Strengthen the inspection and education of the staff, the establishment of an assessment system to achieve clear rewards and punishments.
(C) to strengthen the communication between doctors and patients, standardize the process, and continuously improve patient satisfaction, so that the majority of insured people's basic medical needs are fully protected.
(D) to promote harmonious medical insurance relations, educate medical personnel to seriously implement the provisions of medical insurance policy. Promote the change of people's concept of medical care, medical treatment and cost consciousness. Correctly guide participants to rational medical treatment, purchase of drugs, and provide good medical services for participants.
(E) to further standardize medical behavior, with high-quality first-class service for patients to create a good medical environment.
4. Report on the work of medical insurance
Under the guidance of the district medical insurance center, the leaders at all levels, the departments concerned attach great importance to the support, strictly in accordance with the national, municipal and district policies and requirements related to urban workers' medical insurance, and conscientiously carry out the "xx urban workers' basic medical insurance designated medical service agreement". Medical Service Agreement for Medical Institutions". By the correct leadership of the leadership team of the president and the hospital medical staff *** with the efforts of the overall operation of the medical insurance work in xx year normal, there is no cost overrun, borrowing card to see a doctor, over the scope of the examination and so on, to a certain extent, with the work of the district medical insurance center, to maintain the safe operation of the fund. Now our hospital on the xx annual medical insurance work carried out self-examination, against the evaluation method of serious investigation, and actively rectify, now the self-examination report is as follows:
First, to improve the understanding of the importance of medical insurance work
In order to strengthen the leadership of the work of medical insurance, our hospital set up a relevant personnel composed of medical insurance work leadership group, a clear division of labor responsibilities to a person from the system to ensure that the work of the medical insurance goals and objectives of the implementation of tasks.
Second, from the system to strengthen the management of medical insurance
To ensure that the system is put in place, the hospital to improve the management system of the medical insurance, combined with the actual work of the hospital, focusing on concentrating on the higher level of arrangements for the work of the medical insurance target tasks. It has formulated regulations on further strengthening the management of medical insurance work and measures for rewards and punishments, and at the same time stipulated the duties of the personnel in each position. The basic medical insurance system is sound, and the relevant medical insurance management information is complete and filed in accordance with standardized management. We have completed all kinds of paperwork, written medical records, nursing records and medical records in a timely manner, and uploaded the real medical insurance information to the medical insurance department in a timely manner.
Third, from the practice of medical insurance work management
The hospital combined with the actual work of the hospital, the strict implementation of the basic medical insurance drug management regulations. All drugs, diagnostic and treatment items and medical service facilities charges to implement the price tag, and provide a detailed list of costs. And repeatedly to the medical staff to emphasize, the implementation of the identity verification of medical personnel to eliminate fraud and other phenomena,
Fourth, through the self-examination of the hospital found that although the work of medical insurance has made significant achievements, but from the requirements of the medical insurance center there are still some gaps, such as the basic work to be further consolidated. Analysis of the above shortcomings, the main reasons for the following aspects:
1, individual medical personnel do not attach importance to the work of medical insurance, business on the medical insurance study is not thorough, not enough to understand, do not know what to do, which should not be done, which should be done in a timely manner.
2, in the process of the patient's visit, there is the phenomenon of medical insurance process is not fully grasp.
3, medical records are not written in a timely and comprehensive
4, failed to accurately upload the insured person admitted, discharged from the hospital diagnosis of diseases and drugs, diagnostic and treatment items and other health insurance data
Fifth, the next step in the work of the main points
In the future, our hospital to more strictly implement the policies and regulations of the health insurance, and consciously accept the medical insurance department's supervision and guidance, according to the above shortcomings, the next major measures. The next major measures:
1, strengthen the medical staff of the relevant health insurance documents, knowledge of learning, from the ideological awareness, to eliminate paralysis.
2, the implementation of the responsibility system, clear leadership and health insurance management personnel in charge of the work of responsibility, strengthen the inspection of medical staff education, the establishment of the assessment system, so that the rewards and punishments are clear.
3, in the future to more strengthen the doctor-patient communication, and strive to build a harmonious doctor-patient relationship, and constantly improve patient satisfaction. So that the majority of participants in the basic medical needs of the full protection, by improving the quality of our medical care and service level, to enhance the participants, the community's acceptance of the work of health insurance and support rate.
5. Medical insurance work report
In order to implement the spirit of the dragon medical insurance 20xx document No. 40, "on the implementation of the medical insurance designated medical institutions fund use of the notice of the research" of the relevant requirements of the hospital immediately organized the relevant personnel in strict accordance with the policy provisions of the urban workers' medical insurance and the requirements of the work of the medical insurance fund. The use of health insurance funds to carry out self-correction work, serious investigation, and actively rectify the situation is now reported as follows:
First, improve the ideological understanding, serious and standardized management
In order to strengthen the leadership of the work of medical insurance, the hospital set up to hospitals in charge of the president as the leader, the relevant departments responsible for the members of the health care leading group, a clear division of labor responsibilities to a person, to ensure that the health care system to ensure that the implementation of the objectives and tasks of the work of medical insurance. The hospital has set up a leading group for medical insurance work with the director in charge of the hospital as a member, clearly dividing the work and responsibilities among people to ensure the implementation of medical insurance goals and tasks systematically. Many times to organize the hospital medical staff to seriously study the relevant documents, for the actual work of the hospital, find gaps, and actively rectify. The company's website has been updated with the latest information about the company's website, including a list of its products and services.
Strictly in accordance with the hospital and the medical insurance center signed the "Liancheng County medical insurance designated medical institutions service agreement" requirements of the implementation of reasonable, legal and standardized medical services, and resolutely put an end to the occurrence of false malicious arbitrage of the medical insurance fund irregularities, to ensure that the safe operation of the medical insurance fund.
Second, the strict implementation of the health insurance management system, optimize the health insurance service management
In order to ensure that the implementation of the system in place, the establishment of a sound management system of the health insurance, combined with the actual work of the department, focusing on concentrating on the higher level of the work of the health insurance work target tasks. It has formulated regulations on further strengthening the management of medical insurance work and measures for rewards and punishments, and also stipulated the duties of the personnel in each position. It manages and archives the relevant medical insurance management information according to the norms. The medical and nursing staff have completed all kinds of documents and uploaded the real medical insurance information to the medical insurance department in a timely manner.
Carrying out quality services, setting up a flow chart for medical treatment, and facilitating medical treatment for insured persons. Strictly implement the basic medical insurance medication management regulations, all drugs, diagnostic and treatment items and medical service facilities charges to implement the price tag, and provide an itemized list of costs, and resolutely put an end to the illegal acts of drug-for-drug, drug substitution and other illegal acts; identity verification of patients, and resolutely put an end to the phenomenon of fraudulent name and hospitalization and other registered beds. Strictly enforcing the regulations on the management of medication and diagnosis and treatment programs under basic medical insurance, and strictly implementing the approval system for medication under medical insurance. For the patients who require or need to use drugs outside the catalog, diagnostic and therapeutic projects are required to seek the consent of the participants and sign the archives.
Third, the establishment of long-term cost control mechanism, to complete the cost control targets
Our hospital medical insurance office in conjunction with the medical, pharmaceutical, nursing front-line medical staff and the relevant departments, the implementation of comprehensive control measures to rationally control medical costs. Strictly require medical staff in the process of diagnosis and treatment should strictly comply with the diagnosis and treatment routine, to achieve the treatment of disease, reasonable examination, reasonable treatment, reasonable use of medication, prohibit excessive examination. Strictly grasp the admission criteria of the insured, discharge criteria, strictly prohibit the outpatient, emergency, detention and outpatient specific projects can be implemented in the treatment of patients admitted to the hospital.
Make full use of the hospital information system, real-time monitoring of the hospital's health insurance patient costs, the proportion of out-of-pocket expenses and excess costs and other indicators, real-time query of the medical costs of hospitalized health insurance patients, access to the details of the costs of hospitalized health insurance patients, and find problems in a timely manner to communicate with the department director and the doctor in charge, and to give the correct guidance.
Strengthen the control of irrational use of drugs, control the growth of drug costs.
Our hospital clearly stipulates that medical staff must implement the examination according to the actual needs of the patient's condition, where the lower cost of the examination can be a clear diagnosis, and shall not carry out the same nature of the other examination items; is not the need of the condition, the same examination items shall not be repeated, the requirement of large-scale instrumentation to achieve a positive rate of 70% or more.
Strengthened the "three basic" training and assessment of medical staff, adjusted and enriched the quality control team and medical quality expert group, requiring medical staff to strictly follow the principles of medical treatment and diagnostic and treatment routines, adhere to the treatment of disease, reasonable treatment, and increase the supervision of various medical links, effectively standardizing medical behavior.
Through the above initiatives, our hospital in the rapid growth of business volume at the same time, the various health insurance cost control indicators remain at a low level. According to the statistical summary, from January to March this year, the hospital outpatient total number of 3,584 people than the same period last year, an increase of 1.42%; discharged 191 people than the same period last year, a decline of 4.5%; outpatient hospitalization rate of 4.96% year-on-year decline of 0.3%; the second rate of return to the hospital of 6.81% year-on-year decline of 0.19%; the total hospitalization cost of 1,088,300 yuan compared to the same period last year, a decline of 10.98%, the Medical insurance fund fee 810,600 yuan year-on-year decline of 9.51%; drug costs 324,900 yuan, down 14% year-on-year, large instrument examination costs 47,100 yuan year-on-year decline of 2.69%; an average of each discharged patient's medical costs 5,697.87 yuan; a decline of 6.78% compared with last year.
Fourth, there are problems
1, due to my hospital surgery in the first quarter of this year to carry out surgical treatment of patients more than the same period, so the cost of consumables and large-scale instrumentation accounted for a slight increase in the proportion of consumables, which consumes 27,100 yuan year-on-year growth of 12.92%; 100 yuan of consumables than the 3.55% year-on-year growth of 0.71%; large-scale instrumentation accounted for 4.33% of the checkups Year-on-year growth of 0.37%.
2, individual medical staff thought on the work of health insurance is not important, the business of health insurance learning is not thorough, medical insurance policy is not enough to understand the disease diagnosis and treatment is not standardized.
V. Rectification measures
1, the organization of the relevant medical staff of the relevant medical insurance documents, knowledge learning.
2, adhere to the reasonable inspection, reasonable diagnosis and treatment, the rational application of medical equipment, auxiliary inspection of patients, diagnosis and treatment, to adhere to the principle of "to ensure that the basic medical care", shall not arbitrarily expand the inspection program, the application of the relevant medical equipment to patients in line with the quality of the reliable and affordable principle, and resolutely put an end to the irrational application.
Through the self-examination and rectification of the hospital's medical insurance work, the hospital's medical insurance work is more scientific and reasonable, and in the future, the hospital will more strictly implement the various policies and regulations of medical insurance, consciously accept the supervision and guidance of the medical insurance department, and improve the quality of our medical care and service level, so that the majority of the insured persons of the basic health care needs to be adequately safeguarded.