按病种分值付费审核实例探讨&#x02014;&#x02014;以福建省某市为例

林茂伟; 余丹

doi:10.19546/j.issn.1674-3830.2023.8.016

中国医疗保险 ›› 2023, Vol. 0 ›› Issue (8) : 101-105. DOI: 10.19546/j.issn.1674-3830.2023.8.016

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按病种分值付费审核实例探讨——以福建省某市为例

林茂伟¹, 余丹²

作者信息 +

Discussion on the Audit Examples Based on DIP——Taking a City in Fujian Province as an Example

Author information +

文章历史 +

摘要

本文研究按病种分值付费（DIP）下的审核方式,提取2022年福建省某市三级医院的全量住院病例医保结算清单数据,通过分析诊断与全部手术和操作的逻辑性、组内费用的偏移、组内医疗机构分布等,归纳DIP结算下的医院异化行为,提出进一步加强医保基金精准监管的政策建议和方法。

Abstract

This article extracts the medical insurance settlement list data of all inpatient cases from a tertiary hospital in a city of Fujian Province in 2022 to study the audit methods under the DIP payment. By analyzing the logic of diagnosis and all surgeries and procedures, the deviation of expenses within groups, and the distribution of medical institutions within groups, the paper summarizes the hospital alienation behaviors under DIP settlement, and offers policy suggestions and methods to further strengthen the precise supervision of medical insurance funds.

导出引用

林茂伟, 余丹. 按病种分值付费审核实例探讨——以福建省某市为例[J]. 中国医疗保险. 2023, 0(8): 101-105 https://doi.org/10.19546/j.issn.1674-3830.2023.8.016

Discussion on the Audit Examples Based on DIP——Taking a City in Fujian Province as an Example[J]. China Health Insurance. 2023, 0(8): 101-105 https://doi.org/10.19546/j.issn.1674-3830.2023.8.016

中图分类号： F840.684C913.7

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