摘要
基于数据驱动价值路径模型,以无锡市智慧医保基金监管实践为背景,运用单案例研究方法,对该市智慧医保基金监管实践的实施成效及实施路径进行了探索研究。研究结果发现:(1)数据驱动的医保基金监管通过事前提醒医生、事中医院自律、事后经办分析3个环节,可有效减少医保基金支出,合理控制医疗费用;(2)无锡市智慧医保基金监管实践从数据获取、数据应用、业务决策3个实施途径相关决策的变化,使医保基金监管相关决策更加科学、合理。
Based on the data-driven value path model,with the background of Wuxi’s smart medical insurance fund supervision practice,a single case study method was used to explore the implementation effectiveness and implementation path of the city’s smart medical insurance fund supervision practice.The study found that:(1) Data-driven supervision of medical insurance funds can effectively reduce medical insurance fund expenditures and reasonably control medical expenses by reminding doctors in advance,self-discipline of Chinese medicine hospitals,and post-event analysis;(2) Smart Medical Insurance in Wuxi fund supervision practice changes in decision-making related to the three implementation paths of data acquisition,data application,and business decision-making,making medical insurance fund supervision-related decisions more scientific and rational.
作者
刘政
严运楼
LIU Zheng;YAN Yunlou(School of Management,Shanghai University of Engineering Science,No.333,Longteng Road,Shanghai,201620,PRC)
出处
《中国医院》
2020年第6期4-7,共4页
Chinese Hospitals
基金
国家社科基金一般项目“养老服务PPP模式的社会资本投资回报机制研究”(17BGL192)。
关键词
数据驱动
医保基金监管
医疗保险
医保控费
data-driven
health insurance fund regulation
health insurance
health insurance expense control
