门诊特定病种申请与打印流程优化

孙琳　夏雪　丁小倩　何彩升

摘要：确诊为恶性肿瘤的广州市医保患者，在我院门诊化疗、放射治疗时可以申请门诊特定病种，享受住院报销范围及比例，但门诊特定病种申请单需由患者、医生手工填写，工作人员转录入系统，患者排队领取批文等过程复杂，花费时间长，存在医保违规风险。我院因此开展了门诊特定病种申请与打印流程优化，本文主要介绍传统申请流程及其不足，分析优化后的系统功能、接口设计等，总结其应用情况，旨在为门诊特定病种管理的规范化、现代化提供参考。

关键词：广州市医保;门诊特定病种在线申请;门诊特定病种;批文自助打印

中图分类号：R-056                                 文献标识码：B                                 DOI：10.3969/j.issn.1006-1959.2020.14.005

文章编号：1006-1959（2020）14-0012-03

Outpatient Specific Disease Application and Printing Process Optimization

SUN Lin，XIA Xue，DING Xiao-qian，HE Cai-sheng

（Department of Information，Cancer Hospital Affiliated to Sun Yat-sen University，Guangzhou 510000，Guangdong，China）

Abstract：Guangzhou medical insurance patients diagnosed as malignant tumors can apply for specific diseases of the outpatient clinic during the outpatient chemotherapy and radiotherapy treatment in our hospital， and enjoy the scope and proportion of inpatient reimbursement. However， the application form for the specific diseases of the outpatient clinic must be filled out manually by the patient and doctor. The process of transcription into the system， patients waiting in line to receive approvals， etc. are complicated， take a long time， and there is a risk of medical insurance violations. Therefore， our hospital has carried out outpatient specific disease application and printing process optimization. This article mainly introduces the traditional application process and its shortcomings， analyzes the optimized system functions， interface design， etc.， summarizes its application， and aims to manage outpatient specific disease management provide reference for standardization and modernization.

Key words：Guangzhou Medical Insurance;Online application for specific diseases in outpatient clinics;Specific diseases in outpatient clinics;Self-printing of approval documents

醫保门诊特定病种是城镇职工、居民以及新型农村合作医疗保险制度改革以来，出现的兼具医保政策、临床疾病分类、医疗费用内涵的专用新名词，主要是指病程较长、适合于非住院连续治疗或在院外长期服药，而且医疗费用较高，经审核保险经办机构批准可以纳入社会统筹基金支付的病种，常见的医保门诊特定病种有高血压、糖尿病、恶性肿瘤等[1]。门诊特定病种的实施不仅降低了恶性肿瘤患者的医疗费用负担，维护了参保人的权益[2]，也在一定程度上缓解了医院床位资源紧张的现状。我院是肿瘤专科医院，2019年约12%～15%的门诊患者符合广州市门诊特定病种的申请条件，患者凭有效的《门诊特定项目证明书》（以下简称门特批文）在门诊化疗、放射治疗可享受住院同等报销待遇。……