会计学院知识库

直至今日，我国城乡居民医保体系已基本实现全面覆盖，人民的生命健康有了切实的保障；但逐渐庞大的医保体系也给医保基金的运营带来了严重的问题，为了保障我国医保制度的资金安全、杜绝医疗资源浪费和降低医疗费用，以维持医保基金的长期收支平衡，DRG(Diagnosis Related Groups，疾病诊断相关分组)支付方式就在这种背景之下诞生了。DRG支付通过对每一疾病诊断相关分组制定医保定额支付标准，以期达到医疗资源利用标准化的目的，从而能够减轻医保基金负担，同时又促使医院对医疗费用自觉进行控制、减少医疗资源浪费的情况。随着医保支付制度改革不断深入推进，我国公立医院也开始探索保证医院公益性的同时达到效益最大化的方法与手段，由于医院的收入将被DRG支付标准锁定，实现成本管理精细化管控成为了唯一可行的效益提升方式。

在此背景下，随着阿米巴模式在我国的广泛实践应用和相关理论的不断完善，研究阿米巴模式在企业之外的应用变得越来越具备可行性和必要性。阿米巴模式作为一种能够提高组织运营效率、实现成本精细化管理的运营管理模式，在DRG支付环境中可以成为医院适应改革要求的方向与思路。文章以天水市X医院为例，通过分析DRG支付改革背景下该医院抓住机遇实现可持续发展遇到的阻碍与应用阿米巴模式的可行性，从划分医院内部各阿米巴单元、构建基于DRG支付阿米巴结算运营流程和内部价格交易机制、单位时间核算机制和DRG-标准临床路径医院阿米巴单元成本管控机制等五个模块出发，建立了以病患诊疗流程为核心的医院阿米巴运营管理模式，为公立医院如何适应时代需求、应对医保支付方式变革提供了一个可行的思路，为我国医院如何在医保支付制度改革下提升运营效率、如何有效的进行精细化成本管控、如何激发医院的内在活力和如何使各科室主动解决药品耗材占收入比重过多的问题提供了解决方案，也为我国的阿米巴模式本土化应用研究贡献了微薄之力。

Today,China's urban and rural residents' medical insurance system has basically achieved comprehensive coverage,and people's lives and health are effectively protected;however,the gradually large medical insurance system has also brought serious problems to the operation of medical insurance funds,in order to guarantee the financial security of China's medical insurance system,eliminate the waste of medical resources and reduce medical costs,in order to maintain the long-term balance of medical insurance funds,DRG (Diagnosis Related Groups) payment method was born in this context,and the DRG payment method is designed to standardize the use of medical resources by setting the medical insurance payment standard for each diagnosis related group,so as to reduce the burden of medical insurance fund,and at the same time, encourage hospitals to control medical expenses and reduce the waste of medical resources.As the reform of the health insurance payment system continues to advance,China's public hospitals have begun to explore ways and means to ensure the public welfare of hospitals while maximizing efficiency.

In this context,with the wide practical application of amoeba model in China and the continuous improvement of related theories,it becomes more and more feasible and necessary to study the application of amoeba model outside of enterprises.As an operation management model that can improve the efficiency of organization operation and realize the refinement of cost management,the amoeba model can be a direction and idea for hospitals to adapt to the reform requirements in the DRG payment environment.Taking Tianshui X Hospital as an example,the article analyzes the obstacles encountered by the hospital to seize the opportunity to achieve sustainable development in the context of DRG payment reform and the feasibility of applying the amoeba model,from dividing each amoeba unit within the hospital,constructing DRG payment-based amoeba settlement operation process and internal price transaction mechanism,unit time accounting mechanism and DRG-standard clinical pathway hospital amoeba unit cost control mechanism.It provides a feasible way of thinking for public hospitals to adapt to the needs of the times and respond to the changes in health insurance payment methods.It provides a feasible way of thinking for Chinese hospitals to improve their operational efficiency under the reform of the health insurance payment system,how to effectively carry out refined cost control,how to stimulate the internal vitality of hospitals and how to make each department take the initiative to It provides a solution to the problem of excessive proportion of drugs and consumables in revenue,and also contributes to the localized application research of the amoeba model in China.