Management practice of the hospital for the medical insurance lump-sum prepayment

VernacularTitle:我院应对医保总额预付的管理实践
Author: Lehui ZHANG ; Yongxiang WEI ; Fang CHEN ; Ying CHEN ; Hongbin ZHENG ; Xiuyun SONG
Publication Type:Journal Article
Keywords: Medical insurance lump-sum prepayment; Diagnosis Related Groups; Mathematical model
From: Chinese Journal of Hospital Administration 2014;30(12):910-912
CountryChina
Language:Chinese
Abstract: 2013 witnessed the full coverage of the medical insurance lump-sum prepayment management at all hospitals above secondary level in Beijing.As a result,medical insurance management of the hospital turned its focus from“ expense settlement” to“ expense management”,with a multidimensional,multi-method,multi-sectoral and multi-index lump-sum prepayment of medical insurance management system set up.Methods and concepts introduced included diagnosis related groups (DRGs) management tools in hospitalization service management; equivalent hospital departments comparison in outpatient service for post management; the concept of total budget management concept,and the “market-operations-finance-performance” linkage mechanism for priority control of drug expenses; and focused management on key patient groups and drug/consumable suppliers.