基于临床实际的医疗费用合理控制系统

Rational Control System for Medical Expenses Based on Clinical Practice

在目前医院主动控费普遍不足的背景下,四川大学华西医院以医疗合规合理性为基础,结合地区医保报销政策,研发了一套基于临床实际的医疗费用合理控制系统。该系统运用大数据和人工智能等手段和方法,建立了符合临床实际的控费知识库,并通过覆盖医疗全过程的智能动态费用控制引擎,实现了系统的自动反馈、自我进化。在满足临床和患者需求的同时,主动实现了对医疗费用的合理控制。这是医疗机构和医保部门在信息化监管方面紧密合作,共同完成合理控费目标的一个成功案例。

Under the background of the current lack of active cost control in hospitals,West China Hospital of Sichuan University has developed a set of reasonable control system of medical expenses based on clinical practice,which is based on the rationality of medical compliance and the policy of regional medical insurance reimbursement.By means of big data and artifi cial intelligence,the system establishes a expenses control knowledge base which is in line with the clinical practice,and realizes the automatic feedback and self evolution of the system through the intelligent dynamic expenses control engine covering the whole process of medical treatment.At the same time of meeting the clinical and patients'needs,it actively realizes the reasonable control of medical expenses.This is a successful case of close cooperation between medical institutions and healthcare insurance departments in information supervision to achieve the goal of reasonable expenses control.