基于医保基金监管视角的医院内部审计数据蓝图设计

Design of hospital internal audit data blueprint based on the perspective of medical insurance fund supervision

随着医疗体制改革的不断推进,医院面临着医保基金监管的严峻挑战和风险。通过内部审计,实现基金监管关口前移,强化风险管理,提升风险挑战能力,是目前医院管理的诉求,也是未来发展的趋势。本文主要基于医保基金监管视角,以医院数据治理体系构建和推进为基础,结合医院内部审计业务特点和需要,设计和建立基于医保基金监管视角的医院内部审计数据蓝图。通过深入探讨数据治理及数据蓝图建设的理论体系,并以广东省A医院为例分享耗材全流程管控内部审计数据蓝图构建的具体实践,分数据集成、数据治理、蓝图构建、应用层建设四个步骤推进,以达到医保基金内部审计所需数据可视、可用、可享的坚实数据基础,助力医院内部审计迈向精细化管理的模式。

With the continuous advancement of medical system reform,hospitals are facing severe challenges and risks in the supervision of medical insurance funds.Through internal auditing,achieving a shift in fund supervision,strengthening risk management,and enhancing risk challenge capabilities are the current demands of hospital management and the future development trend.This article is mainly based on the perspective of medical insurance fund supervision,based on the construction and promotion of hospital data governance system,combined with the characteristics and needs of hospital internal audit business,to design and establish a blueprint for hospital internal audit data based on the perspective of medical insurance fund supervision.By delving into the theoretical system of data governance and data blueprint construction,and taking Guangdong A Hospital as an example,sharing the specific practice of constructing an internal audit data blueprint for the full process control of consumables,the process is divided into four steps:data integration,data governance,blueprint construction,and application layer construction,in order to achieve a solid data foundation for the visualization,availability,and enjoyment of the data required for internal audit of medical insurance funds,assist hospital internal audit to move towards a refined management model.