上海市医保信息化监管成效及完善建议

Effect of Medical Insurance Informatization Supervision and Suggestions for Improvement in Shanghai City

上海市医疗保险监督管理方法经历了医保信息化监管从无到有、从有转优的发展过程。由使用计算机浏览寻找违规问题,发展到开发简单程序后对违规项目进行筛查,进而发展到对参保人异常就诊行为的网上监控、初步建立违规预警监控指标体系,极大地提升了医保监管的及时性、准确性和有效性。

Shanghai has set up an information system on medical insurance supervision.There were several stages in the process of informatization.At first we looked for violations through screening computers. Then we developed programs and screened the illegal items through programs. Now it can monitor the insured＇s behavior on line and inform the supervisor through early-warning monitor system. Informatization has improved the instantaneity, accuracy and effectiveness of supervision in medical insurance.