Research On Lean Management Strategy Of Tertiary Public Hospitals For Medical Insurance Refusal ——Take The M Hospital As An Example

Objective: By analyzing the medical insurance violations and default projects in public hospitals,summarizing the causes,discussing the application of lean management theory in the relevant links of medical insurance refusal management in public hospitals,finding reasonable and effective improvement methods,standardizing the diagnosis and treatment process,and providing implementation suggestions and countermeasures for effectively improving the management quality of hospitals.Methods: From the sample hospital internal health insurance agreement,system documents,annual work report,the agency,and the sample hospital from 2019-2021 problem,based on lean management cause analysis method（"bone drawing method","five why"）and personnel interview,the improvement strategy based on lean management problem improvement method（error prevention method,standardized operation,etc.）.Results:According to data analysis of sample hospitals,the largest amount was 51.96%,the amount was 23.09%,16.66%;due to inspection,7.00%;due to treatment,1.29%;major violation of medical insurance restrictions,no indication,over-medication,non-compliance,reduced hospitalization admission,overcharge,irregular charges,and excessive inspection,etc.Conclusion: Based on the root cause analysis of lean management,eliminating waste and improving the process is conducive to reducing the refusal of medical insurance in public hospitals,improving the management level of public hospitals,and improving the reasonable diagnosis and treatment capacity of public hospitals.This paper puts forward targeted and systematic improvement strategies for the problem of refusal of medical insurance in public hospitals from five aspects: drugs,admission and discharge standards,charges,examination and treatment.