厦门医保医疗费用网上预警的优势与潜力

The Advantages and Potential of Online Early Warning System of Medical Insurance Expenses in Xiamen

目前医保网上预警虽能捕捉许多异动点,但未将其串成线、连成面,缺乏对医疗保险医疗费用的综合、连续性分析能力。应根据医保医疗服务行为中各元素的内在关联建立指标体系,根据层进式预警思路设计预警系统,根据标准化需要制定预警操作流程,根据指标体系全面排查各级各类指标,根据费用发生不同特点适时调整阈值。

The current medical insurance online early warning system can capture many change points. Due to lack of comprehensive and constant analysis ability on medical insurance expenses, they cannot be stringed into a line, and further into a surface. We should establish the index system according to the internal relationship of each element in the medical service behavior, design the early warning system according to the thought of layer type early warning system, establish the early warning procedures according to the standardization needs, conduct a comprehensive investigation with various indicators in the index system, adjust the threshold according to the different characteristics of expenses.