Research On Prepaid Medical Insurance Cost Control Strategy In A Hospital Based On CN-DRG

China’s medical insurance adheres to the principle of providing high-quality medical services to residents,and aims to solve the contradiction between "difficult to see a doctor" and "expensive to see a doctor".At present,some achievements have been made,but there are still some problems such as unreasonable medical costs rising fast the contradictions have intensified,and the risks of medical insurance funds have increased year by year.In order to meet the needs of different population groups,different diseases and medical service characteristics in our country,the national medical and health departments have implemented payment methods grouped by CN-DRGs(China Diagnosis Related Groups)under the premise of total prepayment,and the new medical insurance payment method will gradually cover all medical institutions and medical services.In this development trend,considering the multilateral constraints from the total amount of prepayment system,disease types,diagnosis and individual differences of patients,it is one of the important links in hospital management to study the optimal control strategy of medical insurance expenses,to reasonably restrain the excessive rise of medical expenses,and to balance the relationship among hospital performance guarantee,medical service optimization and medical insurance regulatory requirements.In view of the above problems,this paper takes a third-class hospital(hereinafter referred to as hospital A)as an example to study the total prepayment medical insurance cost control strategy and related implementation safeguard measures based on CN DRGs grouping principle.The main research contents are as follows:First,it analyzes the current research background and significance of China’s medical insurance situation,and introduces international research achievements in DRGs and China’s CN-DRGs.It also expounds the technical route and research method of improving the management and control strategy of prepaid medical insurance expenses of A hospital based on the grouping principle of CN-DRGs.Secondly,the basic concepts and related principles of CN-DRGs and ICD-10 are clarified,and their advantages in medical payment are analyzed.By comparing medical insurance payment methods in operation in China,the relevant principles of the prepayment medical insurance payment method are explained.According to the overall situation of the A hospital,the current status and problems of the control methods of the A hospital under the prepaid medical insurance payment are proposed,and the causes of the problems are analyzed.Finally,based on the actual medical cost data of A hospitals and the related cost calculation model based on CN-DRGs,based on this,the A hospital prepaid medical insurance cost management and control strategy was optimized and further researched on supporting organizational security,information security and performance system security and other measures to ensure the effective implementation and continuous improvement of the proposed strategy.