Construction of Medical Insurance DRG Refined Supervision and Precise Governance System:Take"Medi-cal Insurance High-speed Railway",Nanjing as An Example
- VernacularTitle:医保DRG精细化监管与精准治理体系构建
- Author:
Shuailong LI
1
;
Yuxin YE
;
Qian XING
;
Renchang DIAO
;
Wenxi TANG
Author Information
1. 中国药科大学国际医药商学院 江苏南京 211198
- Keywords:
healthcare insurance;
DRG refined theory;
supervision and governance system;
informatization
- From:
Chinese Hospital Management
2024;44(2):6-10
- CountryChina
- Language:Chinese
-
Abstract:
Taking the reform of DRG payment methods as the background,it discusses how the medical in-surance department uses information technology to achieve refined monitoring and management of medical institu-tions,so as to improve the quality and efficiency of medical services and control the unreasonable growth of medical expenses.The three stages of"precision monitoring-refined supervision-precision governance"of medical insurance DRG based on"refined theory"are proposed;taking Nanjing's"medical insurance high-speed railway"as an example,a DRG refined supervision and governance model framework is constructed,and its analysis is carried out monitoring elements and governance elements,and finally put forward implementation suggestions,including hori-zontal collaboration led by medical insurance,establishing a service and cost evaluation mechanism that combines in-ternal and external services.
