中国农村卫生事业管理2025，Vol.45Issue(12)：864-869,6.DOI:10.19955/j.cnki.1005-5916.2025.12.006
医院医保基金网格化管理模式构建与思考
Construction and practical considerations of the grid-based management model for hospital medical insurance funds
RAO Yuanping 1SU Huixuan 2CHEN Ying2
作者信息
- 1. The Ninth Affiliated Hospital of Guangxi Medical University(Beihai People's Hospital),Beihai,Guangxi Zhuang Autonomous Region 536000,China
- 折叠
摘要
Abstract
Objective To explore the construction of a grid-based supervision model for hospital medical insurance funds,aiming to enhance regulatory efficiency and ensure the utilization security of medical insurance funds.Methods A tertiary hospital in City B was selected as the implementation subject.A three-tier grid link-age system was designed,grid-based management was implemented,and the model's effectiveness was validated through practical evaluation.Results In 2024,the detection rate of problematic cases in grid-based operations showed a progressive upward trend,effectively reducing regulatory blind spots.Grid-based management integrated supervisory resources,facilitated the integration of"healthcare services+medical insurance,"enhanced the ca-pabilities of regulatory personnel,and preliminarily established an efficient and precise supervision system.Con-clusions The grid-based management model significantly improves the supervision efficiency of medical insurance funds,achieving comprehensive and refined control.Future efforts should focus on strengthening informatization,optimizing incentive-disincentive mechanisms,promoting cross-departmental collaboration,and establishing a sus-tainable long-term regulatory framework.关键词
网格化/医保管理/基金监管/事中监管/整改率/智能监管Key words
Grid-based management/Medical insurance management/Fund supervision/In-process su-pervision/Rectification rate/Intelligent supervision分类
医药卫生引用本文复制引用
RAO Yuanping,SU Huixuan,CHEN Ying..医院医保基金网格化管理模式构建与思考[J].中国农村卫生事业管理,2025,45(12):864-869,6.
