新医保下特病智能控费系统的开发与应用探讨

Development and application of intelligent cost control system for special diseases under new medical insurance

为一线医师提供全区域内特病年度用药明细,避免医保统筹超限扣款。通过医保国家标准接口,定时获取本地用药全量信息,汇总数据后结合用量规范及院内控费规则,为医师提供辅助决策。重庆医科大学附属第三医院相关科室的使用结果显示,该系统能基本满足医保特病控费的需要。基于全区域内特病用药汇总的门诊特病智能控费系统可基本满足临床医师的需求,也能根据后续改进,进行更加精细的管控。

The objective is to provide the annual medication details of special diseases in the whole region for front-line doctors and avoid deduction of money beyond the limit of medical insurance planning. The system was made by using the national standard interface of medical insurance. It can regularly acquire the complete local medication information, and provide assistant decision-making for doctors combining the dosage specification and fee controlling rules of the hospital after summary of the data was made. According to the results of related departments of The Third Hospital Affiliated to Chongqing Medical University, this system can basically satisfy the needs of cost control of medical insurance of special diseases. The intelligent outpatient cost control system for special diseases based on the collection of medication of special disease in the whole region can basi-cally meet the needs of clinicians, and can also be further improved to make more elaborate manage-ment and control.