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目的:对医保工作人员干预前后的医保患者冒名住院情况进行分析,评价医保工作人员对医保患者冒名住院情况实施干预的效果。方法:选取2010~2011年医保住院患者2041人为对照组,另选取2012~2013年医保住院患者4750人为干预组。比较两组医保患者冒名住院被医保工作人员阻止刷卡率,以及两组医保患者冒名住院导致医保基金拒付率。结果:对照组和干预组冒名住院被医保工作人员阻止刷卡率分别为0.59%和1.60%,对照组和干预组冒名住院导致医保基金拒付率分别为0.88%和0.04%,差异具有统计学意义。结论:采取医保工作人员干预措施,加强了医务人员的责任心,大大减少了医保患者在办理住院时冒用医保卡的现象发生,避免了由于冒名住院给医院带来的经济损失及不必要的医疗纠纷。
Objective: To analyze the imposition of hospitalization for Medicare patients before and after the intervention by Medicare staff, and to evaluate the effect of medical staff intervention on the imposition of hospitalization for Medicare patients. Methods: Totally 2041 inpatients were selected as the control group from 2010 to 2011. 4750 inpatients from 2012 to 2013 were selected as the intervention group. Comparison of two groups of Medicare patients falsified hospitalization staff to prevent credit card rate, as well as two groups of Medicare patients impose hospitalization lead to medical insurance fund protest rate. Results: The imposition rate of 0.59% and 1.60% in the control group and the intervention group were impaired, and the rate of protest in the control group and the intervention group was 0.88% and 0.04% respectively, the difference was statistically significant . Conclusion: The medical staff intervention measures to strengthen the medical staff’s sense of responsibility, greatly reducing the Medicare patients in the hospital for the use of Medicare card phenomenon, to avoid the impostor hospital to the hospital due to the economic losses and unnecessary Medical Dispute.