敏捷治理驱动的医院医保管理优化路径&#x02014;&#x02014;以湖北省武汉市某医院为例

郭小会; 沈冰洁; 夏舒凡; 左后娟; 陈倩

doi:10.19546/j.issn.1674-3830.2025.10.010

中国医疗保险 ›› 2025, Vol. 0 ›› Issue (10) : 90-96. DOI: 10.19546/j.issn.1674-3830.2025.10.010

医疗视点

敏捷治理驱动的医院医保管理优化路径——以湖北省武汉市某医院为例

郭小会, 沈冰洁, 夏舒凡, 左后娟, 陈倩

作者信息 +

Agile Governance-Driven Optimization Path for Hospital Medical Insurance Management——Taking a Hospital in Wuhan City of Hubei Province as an Example

Author information +

文章历史 +

摘要

本文基于敏捷治理理论,探讨了医院医保管理面临的挑战及优化路径。随着医保政策的常态化调整、医保患者规模的扩大以及信息化需求的增长,传统医保管理模式已难以满足当前需求。敏捷治理理论强调灵活性、适应性和以人为本,为医院医保管理提供了新的视角。本文提出通过确立价值引领、优化组织结构、强化环境适应的优化路径,推动医院医保管理的敏捷化转型。以湖北武汉某医院医保管理中敏捷治理理论的应用为例,阐释医疗机构将该理论用于医保管理实践的举措,并选择单独支付药品的申请备案审批和处方流转这一高频业务流程的改造作为案例,展示了敏捷治理在医保管理中的实践应用。研究认为,敏捷治理是提升医院医保管理效率和服务质量的重要方法,为医疗保障领域的改革和创新提供了新思路。未来,应进一步完善敏捷治理机制,以适应医疗保障领域的发展需求。

Abstract

Based on agile governance theory, this study explores the challenges and optimization paths in hospital medical insurance management. With the frequent adjustments of medical insurance policies, the expanding scale of insured patients, and the growing demand for digitalization, traditional medical insurance management models have become inadequate. Agile governance theory which emphasizes flexibility, adaptability, and people-centric principles offers a new perspective for hospital medical insurance management. This paper proposes optimization paths through value-driven leadership, organizational restructuring, and enhanced environmental adaptability to advance the agile transformation of hospital medical insurance management. Taking the application of agile governance in a hospital in Wuhan City of Hubei Province as a case study, it elaborates on practical measures for implementing this theory in medical insurance management. Specifically, the redesign of high-frequency workflows—such as the application, filing, and approval processes for separately reimbursable medications and prescription circulation—demonstrates the practical application of agile governance in medical insurance management. The findings suggest that agile governance is a significant method to improve management efficiency and service quality, providing innovative insights for healthcare security reform. Future efforts should further refine agile governance mechanisms to meet the evolving demands of the healthcare security sector.

导出引用

郭小会, 沈冰洁, 夏舒凡, 左后娟, 陈倩. 敏捷治理驱动的医院医保管理优化路径——以湖北省武汉市某医院为例[J]. 中国医疗保险. 2025, 0(10): 90-96 https://doi.org/10.19546/j.issn.1674-3830.2025.10.010

Agile Governance-Driven Optimization Path for Hospital Medical Insurance Management——Taking a Hospital in Wuhan City of Hubei Province as an Example[J]. China Health Insurance. 2025, 0(10): 90-96 https://doi.org/10.19546/j.issn.1674-3830.2025.10.010

中图分类号： F840.684 C913.7

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