成都医保信息化助推治理能力提升

Promoting the Governance Capacity of Medical Insurance by Information Construction

成都市以信息化建设为抓手,全力推进智能辅助审核、实时在线监控、廉政风险防控、社会监督、个人权益维护等五大子系统,初步实现医疗保险管理由人工监管向智能监管,随机抽查向全面覆盖,事后审查向事前预防、事中监控、事后追责,自体监督向自体和异体监督相结合的转变,医疗保险治理能力得到明显提升。

Taking information construction as a key point in Chengdu, five-subsystems, i.e., smart subsidiary auditing, real-time online monitoring, corruption risk preventing and controlling, social supervising, personal rights and interests maintaining, has been intensively promoted. It has preliminarily implemented following changes in medical insurance supervision, i.e., from manual supervision to intelligent supervision, from random supervision to universal supervision, from afterward auditing to pre-prevention, intermediate supervision, post-blaming, and from self supervision to combined self-supervision and other-person supervision. As a result, the health insurance management ability has been significantly improved.