Study On The Management Of Medical Insurance Policies For A Tertiary General Hospital In Yunnan Province

With the deepening of the reform of the national medical and health system,China's social security system is also constantly reforming and improving.China has established two medical insurance systems for urban workers' medical insurance and urban and rural residents' medical insurance.The coverage of medical insurance covers the total population of China.More than 95%of the national health insurance system was initially established in China.At present,China's medical insurance agencies pay mainly for the payment of fixed-point medical institutions,such as paying by project,paying according to the total prepayment system,paying for the average hospitalization fee,paying for the single disease,and paying for the DRGs.According to the actual situation of each place,local medical insurance agencies choose several ways to pay,and continue to innovate the payment method of medical insurance with the development of the times.In the context of universal health insurance,the main source of expenses for medical institutions has become the payment for medical insurance.The payment method for medical insurance has affected the operation and management of medical institutions.In the face of changes in the payment method of medical insurance under the new situation,the hospital should take corresponding measures to deal with it.By transforming the traditional operation mode,we will focus on improving medical technology,realizing the refinement of cost control,improving production efficiency,reducing operating costs,and reducing the burden of medical expenses for patients,thereby fulfilling the social responsibility of hospitals and promoting hospitals in the market economy.Sustainable development in the environment.It can be seen from the documents and notices issued by the government in recent years that the state is vigorously promoting and improving the payment system for medical insurance policies and expanding the scope of payment for diseases.The impact of the medical insurance policy payment system on the hospital will also gradually expand.The traditional hospital-based management method based on project payment has obviously not adapted to the management requirements of medical insurance policy.How to quickly adapt to new forms,change management models,and innovate management methods,transforming the traditional hospital-based management mode of project-based payment into a hospital management model under a single-patient payment method is a major problem for medical institutions.Medical care itself is a complicated process,interlocking,involving multiple departments and disciplines,and the medical technology level of each hospital is different.It is necessary to do a good job in the management of medical insurance policies,and cannot simply copy the management mode of other hospitals.It is necessary to combine the hospital's own hospital conditions,from different angles,to introduce appropriate measures,combine clinical pathway management with medical cost structure management,improve the diagnosis and treatment process,reduce unreasonable charges,and promote medical personnel in the process of treating patients with medical insurance.To achieve reasonable inspection,rational use of drugs,reasonable treatment,compliance charges,in order to improve the quality of clinical single disease management,to achieve the purpose of improving the implementation rate of hospital health insurance policy.This paper will focus on this issue,using case study method,hospital quality management related management theory and method,through the investigation of the implementation rate and implementation status of the management of traditional Chinese medicine policy in a hospital in Yunnan Province,the clinical department of the hospital Conduct on-the-spot investigation and research on the implementation process of medical insurance policy,combined with the hospital's own situation,study the current status of the hospital's medical policy,and then use the hospital quality control circle method to analyze the root cause and find out the true cause of this situation.Using the relevant theories of public management,reviewing the literature and combining the author's many years of work experience,and formulating corresponding measures,combining clinical path management with cost accounting,transforming the disease treatment link into a reasonable disease charging project,and the feasibility and efficiency of each link.Sexuality verification.Formulate a standardized cost structure for medical insurance policy,and establish an effective cost management mechanism to encourage clinical departments to proactively regulate costs,standardize medical behavior,reduce randomness in medical treatment,improve medical technology and service quality,and improve The implementation rate of medical insurance policy in clinical departments will enhance the comprehensive competitiveness of hospitals.