Research On The Hospital Medical Insurance Refined Management Under Diagnosis-Intervention Packet(DIP)

Objective:In this paper,the Hospital X of Guangzhou,the pilot city of the policy of Diagnosis-Intervention Packet(DIP),was taken as an example.The construction of the current medical insurance management system and the management measures of Hospital X were summarized,and the effects of implementing the refined management of medical insurance on the cost control of the hospital and the expenses of insured patients were analyzed.This paper aims to discuss whether the refined management of medical insurance under DIP can help hospitals to control medical expenses reasonably,improve medical service capacity and efficiency,implement medical insurance fund supervision,effectively protect patients’ medical insurance rights and interests,and furthermore,to provide practical reference for other hospitals to implement refined management of medical insurance.Methods:The data for this study were obtained from the inpatient case home page data and medical insurance billing data of Hospital X,a public tertiary hospital in Guangzhou,from 2016-2021.The relevant indicators collected include:hospitalization number,times of hospitalizations,person category,admission date,discharge date,disease category,disease combination name,disease combination code,disease category,deviation case,hospitalization days,score,total amount of inpatient medical expenses,billing amount,department,standard score,balance,core disease,comprehensive disease,primary disease,CMI,surgery level,etc.A total of 116,379 inpatient data was available for this study,and a descriptive analysis of the homepage data in Hospital X from 2018-2021 was conducted with SPSS 22.0,followed by an interrupted time series to analyze the impact of the implementation of the health insurance refined management measures.Results:According to the interrupted time series analysis,the adoption of total control on medical costs after the implementation of the DIP policy has to a certain extent,curbed the rising trend of medical costs,reduced the total cost of hospitalisation and relieved the economic burden for the patients.Facing the policy change,whether the hospital made timely management adjustments or not will produce different effect on the hospital operation.In the absence of intervention,the cost control effect is poor in Hospital X;after the implementation of refined management,the hospital cost control effect improved significantly,and the hospital operated well.Conclusions:In the process of implementing the value-based payment by disease,hospitals need to adjust their medical insurance management concepts according to the policy changes,combine the refined management model to intervene in clinical departments,and take the spirit of the policy as the guide to make clinical departments return to the essence of medical treatment,achieve reasonable examination,reasonable drug use,reasonable treatment,and standardized charges,and reasonably control medical costs to achieve a win-win situation for hospitals,medical insurance and patients.