“智慧医疗”模式下医院医保全流程结算体系的建立

Establishment of Hospital Whole Process Settlement System Under the"Smart Medical"Mode

近年来,有关构建以患者为中心的智慧医疗服务体系理念逐步成为医院信息化建设的重点,全国医疗保障信息平台的上线为医院智慧化服务发展提供了契机。相比以往多个医保系统,新医疗保障平台解决了系统割裂、数据规范不统一的缺点,利用其兼容多种交易介质的特性和丰富的接口服务,医院能充分利用信息化手段对医保服务进行升级,构建以人工窗口、自助终端、移动终端为基础的一体化医保结算体系,有效解决了患者就诊期间多点往返排队等待的问题。本文以医保结算为例,阐述了该结算体系建立的原理和过程,探索了医保服务和信息技术融合的新途径,以期为智慧医院建设提供一种新思路。

In recent years,the concept of building a patient-centered intelligent medical service system has gradually become the focus of hospital informatization construction.The launch of the national medical security information platform has provided an opportunity for the development of hospital intelligent services.Compared with many medical insurance systems in the past,the new medical insurance platform has solved the shortcomings of system fragmentation and inconsistent data specifications.It is compatible with a variety of transaction media,so that the hospital can make full use of information technology to upgrade medical insurance services,built an integrated medical insurance settlement system based on artificial windows,self-service terminals and mobile terminals,and effectively solved the problem of patients running back and forth and often queuing up during medical treatment.Taking medical insurance settlement as an example,this paper expounds the principle and process of establishing the model settlement system,explores a new way of integrating medical insurance services and information technology,and provides a new idea for the construction of smart hospitals.