Construction of Medical Insurance DRG Refined Supervision and Precise Governance System:Take"Medi-cal Insurance High-speed Railway",Nanjing as An Example
Li Shuailong
Ye Yuxin
Xing Qian
Diao Renchang
Tang Wenxi
Abstract：Taking the reform of DRG payment methods as the background,it discusses how the medical in-surance department uses information technology to achieve refined monitoring and management of medical institu-tions,so as to improve the quality and efficiency of medical services and control the unreasonable growth of medical expenses.The three stages of"precision monitoring-refined supervision-precision governance"of medical insurance DRG based on"refined theory"are proposed;taking Nanjing's"medical insurance high-speed railway"as an example,a DRG refined supervision and governance model framework is constructed,and its analysis is carried out monitoring elements and governance elements,and finally put forward implementation suggestions,including hori-zontal collaboration led by medical insurance,establishing a service and cost evaluation mechanism that combines in-ternal and external services.
Keywords：healthcare insuranceDRG refined theorysupervision and governance systeminformatization
Publication Date：2024-02-05
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 6-10 )