1. Work report on medical insurance
First, attach great importance to it, strengthen leadership and improve the responsibility system for medical insurance management. After receiving the notice, our hospital immediately set up a self-inspection leading group with the main leaders as the team leader and the leaders in charge as the deputy team leader. According to the relevant standards, we found the shortcomings and made positive rectification. We know that basic medical care is an important part of the social security system. Deepening the basic medical insurance system and policy is an inevitable requirement for the development of socialist market economy and an important measure to ensure basic medical care for employees and improve their health level. Our hospital has always attached great importance to medical insurance, set up a special management team, improved the management system, held several special meetings for research and deployment, and regularly trained doctors in medical insurance. At the beginning of the year, the medical insurance work plan was formulated, the medical insurance work was summarized regularly, and the medical care and expenses of the insured patients were analyzed.
Two, standardize management, realize the standardization, institutionalization and standardization of medical insurance services.
In recent years, under the correct leadership and guidance of the Municipal Labor Bureau and the Municipal Medical Insurance Department, various rules and regulations such as the basic medical insurance referral management system, hospitalization process, medical insurance work system, fee bill management system and outpatient management system have been established and improved. Set up "basic medical insurance policy publicity column" and "complaint box"; Compile and publish basic medical insurance publicity materials; Publish the telephone number xxxx for consultation and complaint; Enthusiastic to provide consulting services for insured persons and properly handle complaints from insured patients. Announce the medical insurance process in a prominent position in the hospital to facilitate the insured patients to seek medical treatment and purchase medicines; Set up a special window for the registration and settlement of medical insurance patients. Simplify the process and provide convenient and high-quality medical services. Insured employees should strictly identify themselves when they are hospitalized, and put an end to false medical treatment and false hospitalization, and to false hospitalization and broken hospitalization. Strictly grasp the admission, discharge and admission standards of patients and the admission standards of intensive care units, implement the principle of treatment due to illness, and ensure reasonable examination, treatment and medication; Medical records shall not be forged or altered. Actively cooperate with medical insurance agencies to supervise and audit the diagnosis and treatment process and medical expenses, and provide medical files and related materials that need to be consulted in time. Strictly implement the charging standards set by relevant departments, and there is no case of charging for independent projects or raising the charging standards.
Strengthen the publicity of medical insurance policies, and organize regular study of documents such as "Compilation of Medical Insurance System for Employees in xx City" and "Catalogue of Payment for Class B Drugs of Basic Medical Insurance in Shandong Province" by departments, so that every medical staff can become more familiar with the catalogue and become propagandists, interpreters and executors of medical insurance policies. The hospital specially sent people to call back the outpatients and inpatients, with a return visit rate of 8 1.4% and a satisfaction rate of 98% with the service quality, which was well received by the insured.
Three, strengthen management, to provide quality assurance for the insured medical treatment.
A, strictly implement the diagnosis and treatment of nursing routine and technical operation procedures. Conscientiously implement the medical core systems such as the first-visit physician responsibility system, the three-level physician rounds system, the handover system, the difficult, critical and dead case discussion system, the preoperative discussion system, the medical record writing system, the consultation system, the graded operation management system and the technical access system.
Second, on the basis of strengthening the implementation of the core system, pay attention to the improvement and continuous improvement of medical quality. We have generally improved the medical quality management control system, assessment system and incentive and restraint mechanism, implemented the three-level medical quality management responsibility system in hospitals, departments and groups, decomposed the medical quality management objectives layer by layer, put the responsibility on people, moved the inspection and supervision barrier forward, went deep into the clinical front line, and found and solved problems and hidden dangers in medical work in time. Standardize the process of morning shift, chief rounds and case discussion. Doctors' prescription right has been re-standardized, and they have been given the right of general prescription, medical insurance prescription, anesthesia prescription and blood transfusion prescription through examination. In order to strengthen the risk control of surgical safety, the surgical qualification entrance examination was carefully organized, and the theoretical examination and surgical observation were carried out for the participants.
Third, employees should memorize the core medical system and strictly implement it in actual clinical work. Actively learn advanced medical knowledge, improve their professional and technical level, improve medical quality, serve patients well, and at the same time strengthen the study and cultivation of humanistic knowledge and etiquette knowledge to enhance their communication skills.
Fourth, medical documents are regarded as an important link to control medical quality and prevent medical disputes. Classification of hospital medical records, preliminary review by department directors, and re-review by hospital quality control. 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, and the medical quality has been significantly improved.
Fifth, strengthen safety awareness, and the relationship between doctors and patients is becoming more and more harmonious. Our hospital has continuously strengthened medical safety education, raised the awareness of quality responsibility, standardized medical operation procedures, established and improved the communication system between doctors and patients, adopted various ways to strengthen communication with patients, and patiently and meticulously explained or explained the illness to patients. Be careful before operation, be skilled in operation and be strict after operation. Further optimize the service process to facilitate patients to seek medical treatment.
By adjusting the layout of departments, increasing the service window, simplifying the medical treatment link and shortening the waiting time of patients. There is a medical consultation desk in the outpatient hall, equipped with drinking water, telephone, wheelchair and other service facilities. Set up an outpatient service desk to provide information guidance and medical services for patients and solve all kinds of difficulties encountered by patients in time. Implement the responsibility system of medical guidance service, accompanying consultation service and first consultation, standardize service terms, strengthen nursing etiquette training, and put an end to the phenomenon of being raw, cold, hard, pushing and pushing. Strengthen the privacy protection of gynecological clinics, reasonably arrange patients' visits, and implement one doctor, one patient and one consultation room to fully protect patients' privacy and make the diagnosis and treatment activities more humanized and comfortable. Pay attention to detail service, distribute cold drinks and hot drinks to the companions who come to the clinic twice a day, and distribute bread to the patients and companions at noon. Over the years, the hospital has provided millet gruel for patients free of charge, and enthusiastically provided nursing services for patients, with meticulous care, meticulous operation and patient answering questions. The postpartum visiting group composed of experienced obstetric and pediatric nursing experts gave health education and guidance to discharged parturients and newborns, which was highly praised by parturients and their families. Through a series of intimate services, the customer service department regularly conducts patient satisfaction surveys, and the patient satisfaction has been above 98%.
Fourth, strengthen hospitalization management, standardize hospitalization procedures and expense settlement.
In order to strengthen the standardized management of medical insurance and fully implement medical insurance policies and regulations, according to the requirements of the municipal medical insurance department, the ward adopts a special green bedside card for medical insurance insured patients, and the medical record is stamped with a special seal for medical insurance. The doctors who received the consultation all managed to treat the disease, make a reasonable examination and use drugs rationally. Strengthen the quality management of medical records, strictly implement the responsibility system for first-time doctors, and standardize clinical medication. Attending doctors should consciously use safe, effective and reasonably priced drugs in the drug list according to clinical needs and medical insurance policies. If it is really necessary to use self-funded drugs, [special] drugs, "Class B" drugs and related self-funded items outside the drug list due to illness, the attending physician should explain the reasons to the insured person, fill in the Informed Consent Form, and attach it to the inpatient medical record after the patient or his family members agree to sign it. The proportion of out-of-catalog services to the total cost should be controlled below 15%.
Five, strictly implement the provincial and municipal price departments of the charges.
Medical expenses are another focus of the insured patients. Our hospital adheres to the expense list system, and the daily expenses are distributed to patients. Only after the patients sign can they be transferred to the toll collection office, so that the insured can clearly understand the consumption.
Maintenance and management of intransitive verb system
The hospital attaches great importance to the maintenance and management of the insurance information management system, and promptly eliminates the obstacles of the hospital information management system to ensure the normal operation of the system. According to the requirements of the Municipal Medical Insurance Office, the medical insurance special computer is required to be dedicated strictly in accordance with the regulations. If there are problems, contact the medical insurance office in time, so that medical expenses cannot be settled due to procedural problems, and the insured person can be settled promptly and quickly.
Always adhere to the patient-centered, quality-centered, and wholeheartedly serve patients as the starting point, strive to standardize the establishment of rules and regulations, the concept of humanized service, standardize medical quality, consciously correct professional ethics, and actively provide high-quality, efficient and inexpensive medical services and a warm medical environment for the insured, which has been well received by the majority of insured people and received good social and economic benefits.
Our hospital carried out strict self-examination in accordance with xx City's "Assessment Standard for Standardized Management of Designated Medical Institutions" and other documents, which met the setting and requirements of designated medical institutions for medical insurance.
2. Medical insurance work report
In accordance with the spirit of the Notice of Luannan County Human Resources and Social Security Bureau on Forwarding 19991February 20th. Tang People's Social Welfare Department 20xx2 1 "and other documents, and with the efforts of the relevant staff in our hospital, our hospital has comprehensively sorted out the insured people who came to our hospital for treatment, and found no cases such as excessive expenses, borrowing cards to see a doctor, out-of-range examination, listing hospitalization, changing medicine with medicine, replacing medicine with things, etc. And to a certain extent, it has maintained medical insurance. The self-inspection work is now reported as follows: 1. Basic management of medical insurance:
1, our hospital has set up a basic medical insurance management team composed of leaders in charge and relevant personnel, which is specifically responsible for the daily management of basic medical insurance.
2, the basic medical insurance system is perfect, the relevant medical insurance management information according to the standard management filing.
3. The medical insurance management team regularly organizes personnel to analyze the use of various medical expenses of the insured. Find problems and solve them in time, and conduct spot checks on medical insurance management. If there are irregularities, they will be corrected immediately.
4, medical insurance management team members actively cooperate with the county social security bureau of medical service price and drug costs supervision and audit, timely provide medical files and related information for reference.
Two, medical insurance service management:
1, to provide quality services for the insured.
2, the drugs, diagnosis and treatment projects and medical service facilities charges clearly marked, and provide a detailed list of costs, and resolutely put an end to illegal activities such as medicine to supplement medicine, replacing medicine with things.
3, verify the identity of the medical staff, and resolutely put an end to the phenomenon of an impostor in hospital.
4. The medical personnel shall obtain the consent of the insured in advance and sign for the record of the drugs and diagnosis and treatment items that are necessary or necessary outside the catalogue.
5, by the drug supervision department to check no drug quality problems.
Three, medical insurance business management:
1, strictly implement the basic medical insurance drug management regulations and the medical insurance drug approval system.
2, according to the basic medical insurance directory required drug preparation rate.
3, check the outpatient prescription, discharge medical records, check the dispensing situation in accordance with the provisions.
4, strictly implement the basic medical insurance treatment project management regulations.
5, strictly implement the basic medical insurance service facilities management regulations.
Four, medical insurance information management:
1, our hospital's information management system can meet the daily needs of medical insurance work, and it is also relatively perfect in daily system maintenance. It can report and actively eliminate the faults of medical insurance information system in time to ensure the normal operation of the system.
2, medical insurance window staff skilled operation skills, medical insurance policy learning actively.
3. The medical insurance data is safe and complete.
Five, medical insurance cost control:
1, strictly implement medical charges and medical insurance quotas.
2. Strictly master the admission and discharge standards, and found no insured who did not meet the hospitalization conditions or deliberately delayed discharge and exceeded the inspection scope.
3. Submit the medical insurance expense report on time every month, and settle the expenses in time.
Six, medical insurance policy publicity:
1. Actively organize medical staff to study medical insurance policies regularly, and timely communicate and implement relevant medical insurance regulations.
2 to set up publicity columns, distribute publicity materials and other forms of publicity and education.
After further self-examination and rectification of medical insurance work in our hospital, the medical insurance work in our hospital is more scientific and reasonable, the professional quality of medical insurance managers and all medical staff in our hospital has been improved, the sense of responsibility has been strengthened, and the bad loss of medical insurance funds has been prevented. With the support and guidance of the Social Security Bureau, the medical work in our hospital has been better.
3. Medical insurance work report
In 20xx, our hospital strictly implemented the policies, regulations and requirements of the higher authorities on medical insurance for urban workers and urban and rural residents. With the guidance and support of leaders at all levels and relevant departments, and with the joint efforts of hospital staff, the medical insurance work has generally operated normally, and no card borrowing, out-of-range inspection and hospitalization have occurred, thus maintaining the' safe operation' of the fund. According to the spirit of the document [20xx] No.276, the leaders of our hospital organized a self-examination of the medical insurance work in 20xx, and carefully checked and rectified the contents of the annual inspection. Now the self-examination situation is reported as follows: 1. Improve the understanding of the importance of medical insurance work.
First of all, our hospital set up a medical insurance leading group with Dean Liang as the team leader, vice president in charge as the deputy team leader, and directors of various departments as members, so as to comprehensively strengthen medical insurance leadership, clarify the division of responsibilities to people, and ensure the implementation of medical insurance objectives and tasks from the system. Secondly, organize all employees to study relevant documents carefully. And in accordance with the requirements of the document, in view of the actual work of our hospital, find the gap, actively rectify, and take medical insurance as a major event. Actively cooperate with the medical insurance department to strictly control the non-conforming treatment items and drugs that should not be used, and do not cross the line. Resolutely put an end to the illegal phenomenon of defrauding medical insurance funds, build a brand of honest medical insurance, strengthen self-discipline management, and establish a good image of designated medical insurance hospitals.
Two, strengthen the management of medical insurance from the system.
In order to ensure the implementation of various systems, our hospital has improved various medical insurance management systems, focusing on the medical insurance objectives and tasks arranged by superiors in combination with our actual work. Formulated regulations and reward and punishment measures to further strengthen the management of medical insurance, and stipulated the responsibilities of personnel in various positions. The basic medical insurance system is sound, the relevant medical insurance management information is complete, and it is managed and filed according to the norms. Carefully and timely complete all kinds of documents, write medical records on time, fill in relevant materials, and upload real medical insurance information to the medical insurance department in time. Regularly organize personnel to analyze the use of various medical expenses of medical insurance users, and find problems and solve them in time.
Three, from the reality to do real medical insurance management.
According to the actual work in our hospital, the regulations on drug management of basic medical insurance are strictly implemented. Spot-check outpatient prescriptions and hospitalization orders, and correct irrational drug use in time. All drugs, diagnosis and treatment items and medical service charges should be clearly marked, and a detailed list of expenses should be provided. The list of expenses should be sent to patients every day, so that they can be transferred to the charging office after the patient signs it, so that the insured can clearly understand the consumption. And repeatedly stressed to the medical staff that it is necessary to verify the identity of medical staff to prevent the occurrence of impersonation. It is also required to obtain the consent of the insured in advance and sign an informed consent form for drugs and medical treatment items needed by medical personnel outside the catalogue. At the same time, strictly implement the responsibility system for the first diagnosis, and there is no phenomenon of shirking patients. There is no bed hanging phenomenon, no decomposition of hospitalization behavior, no over-examination, repeated examination and over-medical treatment behavior. Strictly abide by the clinical and nursing diagnosis and treatment procedures, and strictly implement the clinical medication routine and the principle of combined medication. In terms of financial settlement, the charging standard of the price department of Sheng City was strictly implemented, and there was no arbitrary charging behavior, and there was no phenomenon that medical expenses that did not belong to the scope of basic medical insurance were included in the scope of medical insurance payment.
Four, strengthen management, to provide quality assurance for the insured medical treatment.
A, strictly implement the diagnosis and treatment of nursing routine and technical operation procedures.
Second, on the basis of strengthening the implementation of the core system, pay attention to the improvement and continuous improvement of medical quality.
Third, employees should memorize the core medical system and strictly implement it in actual clinical work.
Fourth, medical documents are regarded as an important link to control medical quality and prevent medical disputes.
Maintenance and management of verb (verb's abbreviation) system
The information management system can meet the needs of medical insurance, the daily maintenance system is perfect, the new policies are introduced or adjusted and revised in time, and the faults of the medical insurance information system can be reported in time and eliminated actively to ensure the normal operation of the system. Strengthen the study and operation skills of medical insurance policy of medical insurance window staff. The information system medical insurance data is safe and complete, and the medical insurance xx network service is regularly checked and disinfected. Regularly take the initiative to organize medical staff to learn medical insurance policies, timely convey and implement relevant medical insurance regulations, and timely understand the medical staff's understanding of medical insurance management policies.
Six, the existing problems and causes analysis
Through self-examination, it is found that although the medical insurance work in our hospital has made remarkable achievements, there is still a certain gap from the requirements of higher authorities, such as related basic work, ideological understanding and professional level, which needs to be further strengthened and consolidated. Analysis of the above shortcomings, mainly for the following reasons:
(a) the relevant regulatory authorities are not strict enough in the usual inspection of medical insurance.
(2) Some staff members do not attach importance to medical insurance work ideologically, do not study medical insurance policies in depth in business, do not grasp the starting point of medical insurance work, and do not know what to do, what not to do, and what to do in time.
(C) In the process of patient treatment, some medical staff did not fully grasp the medical insurance process.
Seven. Next step
In the future, our hospital should strictly implement the policies and regulations of medical insurance and consciously accept the supervision and guidance of the medical insurance department. And put forward rectification measures:
(1) Strengthen medical staff's standardized study of medical insurance policies, documents and knowledge, improve their ideological understanding and put an end to carelessness.
(two) the implementation of the responsibility system, clear leadership and medical insurance management responsibilities. Strengthen the inspection and education of employees, establish an assessment system, and distinguish rewards and punishments.
(three) to strengthen the communication between doctors and patients, standardize the handling process, and constantly improve patient satisfaction, so that the basic medical needs of the majority of insured persons are fully guaranteed.
(four) to promote the harmonious relationship between medical insurance, education of medical personnel to seriously implement the provisions of the medical insurance policy. Promote the change of people's medical concept, mode and cost consciousness. Correctly guide the insured to seek medical treatment and purchase medicines reasonably, and provide good medical services for the insured.
(5) Further standardize medical behaviors and create a good medical environment for patients with high-quality and first-class services.
4. Medical insurance work report
Under the guidance of the district medical insurance center, with the support of leaders at all levels and relevant departments, and in strict accordance with the policies, regulations and requirements of the state, city and district on medical insurance for urban workers, we will conscientiously fulfill the Medical Service Agreement of designated medical institutions for basic medical insurance for urban workers in xx City. Thanks to the correct leadership of the leading group headed by the president and the joint efforts of the medical staff in our hospital, the medical insurance work in xx was generally running normally, and there were no cases such as excessive expenses, borrowing cards to see a doctor and out-of-range inspection. To a certain extent, it cooperated with the work of the district medical insurance center and maintained the safe operation of the fund. At present, our hospital has conducted a self-examination on xx medical insurance, and made a careful investigation and rectification according to the evaluation method. Now the self-examination situation is reported as follows: 1. Improve the understanding of the importance of medical insurance.
In order to strengthen the leadership of medical insurance, our hospital set up a medical insurance work leading group composed of relevant personnel, defined the division of responsibilities to people, and ensured the implementation of medical insurance work objectives and tasks from the system. Organize all the staff to study the relevant documents carefully for many times, find out the gap, and actively rectify according to the actual work in our hospital. Focusing on the future and keeping pace with the times, * * * will discuss the next medical insurance work and create a new situation of harmonious medical insurance. Our hospital regards medical insurance as a major event in the hospital, actively cooperates with the medical insurance department to strictly control non-conforming treatment items and drugs that should not be used, and resolutely puts an end to the illegal phenomenon of defrauding medical insurance funds. Strengthen self-discipline management and promote our hospital to strengthen self-supervision, self-management and self-discipline. Further establish a good image of designated hospitals for medical insurance.
Two, strengthen the management of medical insurance from the system.
In order to ensure the implementation of various systems, the hospital has improved various medical insurance management systems, focusing on the medical insurance objectives and tasks arranged by superiors in combination with the actual work of our hospital. Formulated regulations and reward and punishment measures to further strengthen the management of medical insurance, and stipulated the responsibilities of personnel in various positions. The basic medical insurance system is sound, the relevant medical insurance management information is complete, and it is managed and filed according to the norms. Carefully and timely complete all kinds of documents, write medical records, nursing medical records and course records, and upload real medical insurance information to the medical insurance department in time.
Three, from the reality to do real medical insurance management.
According to the actual work of our hospital, the hospital strictly implements the regulations on the management of basic medical insurance drugs. All drugs, diagnosis and treatment items and medical service facilities should be clearly marked and a detailed list of expenses should be provided. And repeatedly stressed to the medical staff that it is necessary to verify the identity of the medical staff and prevent the phenomenon of impersonation.
Fourth, through self-examination, it is found that although the medical insurance work in our hospital has made remarkable achievements, there is still a certain gap from the requirements of the medical insurance center, such as the basic work needs to be further consolidated. Analysis of the above shortcomings, mainly for the following reasons:
1, individual medical staff do not attach importance to medical insurance work ideologically, do not study medical insurance in depth, have insufficient understanding, and do not know what to do, what not to do, and what to do in time.
2. In the process of seeing a doctor, there is a phenomenon that the medical insurance process is not fully mastered.
3. The writing of medical records is not timely and comprehensive.
4. Failing to accurately upload the medical insurance data such as the disease diagnosis, drugs, diagnosis and treatment items of the insured.
Verb (abbreviation of verb) is the key point of the next step.
In the future, our hospital should strictly implement the policies and regulations of medical insurance and consciously accept the supervision and guidance of the medical insurance department. In view of the above shortcomings, the next step is mainly to take measures:
1, strengthen the study of medical staff's medical insurance documents and knowledge, improve their understanding ideologically, and put an end to carelessness.
2, the implementation of the responsibility system, clear in charge of the leadership and medical insurance management responsibilities, strengthen the inspection and education of medical personnel, establish an assessment system, so that rewards and punishments are clear.
3. In the future, we should strengthen the communication between doctors and patients, strive to build a harmonious relationship between doctors and patients, and constantly improve patient satisfaction. The basic medical needs of the insured are fully guaranteed. By improving the medical quality and service level of our hospital, the recognition and support rate of the insured and all sectors of society for medical insurance work will be enhanced.
5. Medical insurance work report
In order to implement the spirit of Long Medical Insurance Document 20xx 40 and the relevant requirements of the Notice on Investigating the Use of Funds in Designated Medical Institutions for Medical Insurance, our hospital immediately organized relevant personnel to conduct self-examination and self-correction on the use of medical insurance funds in strict accordance with the policies, regulations and requirements of medical insurance for urban workers, carefully investigate and actively rectify, and now report the self-examination as follows: 1. Improve ideological understanding and seriously standardize management.
In order to strengthen the leadership of medical insurance, our hospital set up a medical insurance leading group with the president in charge of the hospital as the team leader and the heads of relevant departments as members, and defined the division of responsibilities to people to ensure the implementation of medical insurance objectives and tasks from the system. Many times, the medical staff of the whole hospital were organized to study the relevant documents carefully, and according to the actual work in our hospital, the gap was found and the rectification was actively carried out. Strengthen self-discipline and self-management.
In strict accordance with the requirements of the Service Agreement of Medical Insurance Designated Medical Institutions in Liancheng County signed by our hospital and the medical insurance center, we will provide medical services reasonably, legally and standardly, resolutely put an end to the illegal phenomenon of defrauding medical insurance funds and ensure the safe operation of medical insurance funds.
Two, strictly implement the medical insurance management system, optimize the management of medical insurance services.
In order to ensure the implementation of various systems, various medical insurance management systems have been established and improved, and combined with the actual work of departments, efforts have been made to focus on the medical insurance objectives and tasks arranged by superiors. Formulated regulations and reward and punishment measures to further strengthen the management of medical insurance, and stipulated the responsibilities of personnel in various positions. Manage and file related medical insurance management data according to standards. Medical staff carefully and timely complete all kinds of documents and upload real medical insurance information to the medical insurance department in time.
Carry out quality services and set up a medical treatment flow chart to facilitate the insured to seek medical treatment. Strict implementation of the basic medical insurance drug management regulations, all drugs, diagnosis and treatment projects and medical service facilities charges shall be clearly marked, and a detailed list of expenses shall be provided, so as to resolutely put an end to the occurrence of illegal acts such as changing medicine and replacing medicine with things; Verify the identity of medical staff and resolutely put an end to the phenomenon of impersonation hospitalization. Strictly implement the basic medical insurance drug management and treatment project management regulations, and strictly implement the medical insurance drug approval system. The off-list drugs and medical treatment items needed or necessary by medical personnel shall be agreed by the insured in advance and signed for the record.
Third, establish a long-term fee control mechanism and complete various fee control indicators.
The medical insurance office of our hospital cooperates with the front-line medical staff of medicine, medicine and nursing and relevant departments to implement comprehensive control measures to control medical expenses reasonably. It is strictly required that medical personnel should strictly abide by routine diagnosis and treatment in the process of diagnosis and treatment, so as to treat diseases, check, treat and use drugs rationally, and excessive inspection is prohibited. Strictly master the admission and discharge standards of insured persons, and it is strictly forbidden to treat treatable patients in outpatient, emergency, observation and outpatient specific projects.
Make full use of the hospital information system, real-time monitor the hospital's medical insurance patient expenses, self-funded proportion and over-limit expenses, real-time query the medical expenses of medical insurance patients in the hospital, check the details of medical insurance patients in the hospital, communicate with the department director and the competent doctor in time when problems are found, and give correct guidance.
Strengthen the control of irrational drug use and control the increase of drug costs. The pharmaceutical affairs management team keeps abreast of doctors' prescriptions through the statistical information of drug prescriptions, takes targeted measures, strengthens the investigation of "big prescriptions", establishes a prescription review system and a drug ranking publicity system, strengthens the management of outpatient and discharged drugs for medical insurance patients, and strictly implements the provisions of the health administrative department on quota management.
Our hospital clearly stipulates that medical staff must check according to the actual needs of patients' condition. Any low-cost examination can make a definite diagnosis, and other examination items of the same nature cannot be carried out. The condition does not need to be repeated, and the same examination item should not be repeated. The positive rate of large instruments should be above 70%.
The "three basics" training and assessment of medical staff have been strengthened, and the strength of quality control team and medical quality expert group has been adjusted and enriched. Medical staff are required to strictly abide by medical principles and routine diagnosis and treatment, adhere to the treatment of illness and reasonable treatment, strengthen supervision over all aspects of medical care, and effectively standardize medical behavior.
Through the above measures, while the business volume of our hospital is growing rapidly, the medical insurance cost control indicators are kept at a low level. According to statistics, the total number of outpatients in this hospital was 3,584 from June to March this year, an increase of 1.42% over the same period last year. The number of discharged patients 19 1 decreased by 4.5% compared with the same period of last year. The outpatient hospitalization rate was 4.96%, which was 0.3% lower than last year. The second rate of return was 6.8 1%, which was 0. 19% lower than last year. The total hospitalization expenses 1088300 yuan decreased by 10.98% compared with last year, and the medical insurance fund expenses10600 yuan decreased by 951%compared with last year; The cost of drugs was 324,900 yuan, down by 65,438+04% compared with last year, and the cost of large-scale instrument inspection was 47,654,38+000 yuan, down by 2.69% compared with last year. The average medical expense of each discharged patient is 5697.87 yuan; It is 6.78% lower than last year.
Fourth, the existing problems
1. In the first quarter of this year, there were more surgical patients than in the same period, and the proportion of consumables and large-scale instruments increased slightly, of which the cost of consumables was 27 1 10,000 yuan, an increase of 12.92% over last year. 100 yuan consumables increased by 3.55% compared with last year, with an increase of 0.71%; Large-scale instrument inspection accounted for 4.33%, an increase of 0.37% over last year.
2. Individual medical personnel do not attach importance to medical insurance work ideologically, do not study medical insurance in depth in their business, have insufficient understanding of medical insurance policies, and are not standardized in disease diagnosis and treatment.
Verb (abbreviation of verb) rectification measures
1, organize relevant medical staff to learn medical insurance documents and knowledge.
2, adhere to the reasonable examination, reasonable diagnosis and treatment, rational application of medical equipment, auxiliary examination, diagnosis and treatment of patients, we must adhere to the principle of "ensuring basic medical care", and shall not arbitrarily expand the inspection items. The application of related medical equipment to patients should be based on the principle of reliable quality and affordable price, and resolutely put an end to unreasonable application.
Through the self-examination and rectification of medical insurance work in our hospital, the medical insurance work in our hospital will be more scientific and reasonable. In the future, our hospital will strictly implement the medical insurance policies and regulations, consciously accept the supervision and guidance of the medical insurance department, improve the medical quality and service level of our hospital, and fully protect the basic medical needs of the majority of insured personnel.