The Amount Of Hospital Health Care Risk Early Warning And Control Research

With the advent of the era of universal health care in our country, our country town worker medical insurance and made medicare patients in the rapid increase year by year,health-care fund pressure. Because our country medical treatment resources more nervous,so adopt internationally popular total mechanism to control the excessive growth of health care costs in advance. In recent years, medical science and technology is developing rapidly in our country, more new medical technology, medical drugs, materials are added to the hospital everyday the process of treating and salving patients, medical health care consumption rising trend is irresistible. The development of our country’s economy is growing by leaps and bounds, residents living standards improve, people pay more attention to, to the health of their demand for hospital to provide medical care is also increasing. In increase in the number of patients, increase in demand and the rapid rise of the price index of s, only a small amount of subsidies by the government for hospitals have been do not guarantee the hospital health care consumption and the hospitals appear to be superior fined, severely hampered the normal development of the hospital, therefore, in the control of coverage on the significant particularly important. In order to solve the problem of coverage control, based on the research of the advanced literature at home and abroad,and combined with the problems encountered in the work of the hospital, the hospital medical insurance credit risk early warning and control end of the paper. Through research we development: coverage overruns lies mainly in excessive treatment, medication, check the situation of frequent, physicians in order to their own interests more use of the high treatment program, can’t reasonable control health care costs of treating patients. At the same time, the leadership to control the coverage of the attention is not enough, the supervision of the financial department no coverage related measures is also linked to an increased amount of part of the reason. Hospital health care work of hospital medical insurance limit the use of some control, mainly reflected in the standardized clinical pathway and branch index strategy, strengthening the study of health knowledge and health care department supervision measures. Measures in the concrete implementation of these methods will encounter this or that kind of some difficulties, to control the coverage of the strength is not enough. Through control M hospital specific health care case study,combined with advanced coverage control technology at home and abroad, put forward the suitable for our country hospital medical insurance credit risk early warning mechanism and control mechanism, mainly has the following several aspects: draw lessons from foreign advanced DRGs cure control way, combined with the attached system, prepaid system, constant ratio quota method combined with multiple lines of single diseases control, continuously reduce the coverage using PDCA strategy, the financial department by will cost overruns part included in the department and overall control the hospital of the cost of subsequent usage, interval, the implementation of the mandate projects through the health office and financial monitoring to prevent excessive use of treatment, medicine, the phenomenon of examination, strengthen exchanges and cooperation on the coverage control of hospitals, to strengthen the related auxiliary department work efficiency, and soon. Through the financial, health, the related clinical departments of internal warning prompt coverage may occur at any time of operation and case, controlled in a timely manner. To analysis and research of risk warning mechanism and applied to the actual use of control mechanism, through the control of the gap between before and after the contrast and analysis of research results and the actual implementation of encounter difficulties, in the process of finding the feasibility of the research plan.Finally, according to the results of the experiment, to health care and credit risk warning and control mechanisms was summed up, and in the future the development direction of hospital coverage control and puts forward some reasonable Suggestions.