大数据下医院医保管理模式的现状与改进策略

The Present Situation and Improvement Strategy of Hospital Medical Insurance Management Mode Under Big Data

完善和发展医疗保险制度是政府的重要任务之一,同时其也是医疗卫生体制改革的关键目标。医疗保险定点医院属于医疗保险制度改革的重要载体,同时也是实施医疗保险政策和控制成本的关键所在。开展医疗保险基金支付工作,需要建立在合理、规范的基础上。在医疗保险管理过程中,医院必须要能够积极适应医疗保险制度,并且通过设置规范的制度和严格的评价措施,切实保障医疗保险政策得以顺利开展。所以院方必须要充分应用大数据相关技术,通过对材料、药品、医疗检查等相关费用的重点监管,实现对医疗费用增长的有效监控,强化医疗保险的管理工作,在保护患者的同时,也充分保护医院的利益,确保医疗保险基金能够安全、稳定的运行。

Perfecting and developing the medical insurance system is one of the important tasks of the government,and it is also the key goal of the reform of the medical and health system.Medical insurance designated hospital is an important carrier of medical insurance system reform,and it is also the key to implement medical insurance policy and control cost.To carry out the payment work of medical insurance fund,it is necessary to establish it on the basis of reasonableness and standardization.In the process of medical insurance management,hospitals must be able to actively adapt to the medical insurance system,and through the establishment of standardized systems and strict evaluation measures,to ensure the smooth development of medical insurance policy.Therefore,the hospital must make full use of big data's related techniques.Through the key supervision of materials,drugs,medical examination and other related expenses,we can effectively monitor the growth of medical expenses,strengthen the management of medical insurance,protect the interests of hospitals while protecting patients,and ensure the safe and stable operation of medical insurance funds.