The first in the country!The medical insurance version of the hospital is released, and these hospitals are on the list

Author:Guangzhou Radio and Television Time:2022.06.22

Does the hospital cooperate with a different place for medical treatment? Is there any violations of "decomposition hospitalization, hanging bed hospitalization, and low standards"? Is the proportion of medical insurance catalogs in the use of medicines in hospitals reached the standard? These are not only related to the medical treatment of each patient, but also the use of medical insurance funds. In the past, the medical insurance department lacked a scientific and complete quantitative evaluation system in the management of medical insurance and medical services in the hospital. Now this gap has been filled in Guangdong.

Recently, the Guangdong Provincial Medical Security Bureau released the "Evaluation Report for Medical Insurance and Medical Service (2021)" in the designated third -level medical institution in Guangdong Province to evaluate, rank, and release the medical services of designated three -level medical insurance and traditional Chinese medicine medical institutions. For the first time in China, the evaluation results may be linked to the medical insurance payment policy to promote the high -quality development of designated medical institutions and it is of great significance to improving the level of medical security in Guangdong Province.

Ranking 8 dimensions to the hospital

According to reports, the scope of this evaluation is 137 three -level fixed -point comprehensive medical institutions and 45 tertiary traditional Chinese medicine medical institutions except for military hospitals and specialist hospitals. During the evaluation process, the Guangdong Provincial Medical Insurance Bureau many times held a demonstration meeting and seminar participated in the provincial medical institutions, colleges and universities, and experts and scholars of scientific research institutions. Evaluation system for third -level indicators.

The evaluation report comprehensively presents the current status of medical insurance and pharmaceutical services and the strategic purchase of medical insurance services for medical institutions, and the total scores of medical insurance services, policy specifications, medical insurance quality, medical insurance operations, sustainable development, and case portfolio index index of designated three -level medical institutions (CMI) and the medical insurance capacity index eight dimensions are ranked.

The "high score" hospital is concentrated in the Pearl River Delta

According to the evaluation report, Guangdong's designated three -level comprehensive medical institutions evaluated the top scores in the top scores in Guangzhou and surrounding cities. Among the top 10 medical institutions, there are 6 in Guangzhou, 2 in Shenzhen, and 1 in Meizhou and Foshan. The top 30 medical institutions are mainly concentrated in the Pearl River Delta. The top 50 medical institutions have not covered cities across the province. 15 of them are concentrated in Guangzhou, and there are no medical institutions in Heyuan City, Shanwei, Chaozhou, and Zhanjiang. It can be seen that there is an uneven phenomenon of the development of medical insurance and pharmaceutical services of the designated three -level comprehensive medical institutions in Guangdong Province.

50 indicators In -depth analysis of the current status of pharmaceutical services

The evaluation report also conducted in -depth analysis of 50 third -level indicators and put forward policy suggestions. These indicators include the completion rate of the national collection and zone procurement of medical institutions, the proportion of medical insurance directory drugs, the growth rate of the average annual hospitalization expenses of the insured, the proportion of the inspection and inspection of outpatient patients, and the intensity of the use of antibacterial drugs. Taking the intensity of antibacterial drugs as an example, the evaluation report pointed out that the current problems are that the overall control of antibacterial drugs at all levels is poorly controlled. Among them, municipal hospitals and county -level hospitals (third -level) control are poor.

Among the 50 tertiary indicators include cerebral infarction, arteriosclerosis heart disease, chronic obstructive pulmonary disease with acute down respiratory tract infections, hip joint replacement, and cesarean section. Han Huidong, director of the Medical Service Management Department of the Guangdong Medical Security Bureau, explained that these diseases are representative and can reflect the fine level, material consumption level, and charging level of medical insurance fund management. Taking hip joint replacement as an example, the evaluation report found that the main problem in teaching and provincial hospitals is that the average number of hip replacement patients is too expensive, while county -level hospitals have the longest in hospital in patients with hip joint replacement and the highest disease mortality rate. The problem.

Evaluation results may be linked to medical insurance payment policies

It is understood that at present, the domestic medical insurance and pharmaceutical service management still lacks a scientific and complete quantitative evaluation system. The results of this evaluation technology plan and analysis will have a demonstration and leading effect on other parts of the country.

How to link the evaluation results with medical insurance payment? It is understood that when the medical insurance fund paid the medical institution, the corresponding weight coefficient was set according to the medical institution level. Generally speaking, the higher the level of the medical institution level, the higher the weight coefficient, the higher the comprehensive ability, the higher the weight coefficient, and the hospital obtains medical insurance. The corresponding income, the more.

Guangdong Province's designated three -level comprehensive medical institution evaluates total scores (10 before)