新时期智慧医保:概念、应用领域及发展策略

Intelligent Medical Insurance in the New Era:Concept,Application Field and Development Strategy

本研究立足于我国新时期医保信息化标准化发展需求,重点从“是什么、建什么、怎么建”等方面廓清新时期智慧医保建设与发展。首先,从比较狭义的数据资源角度和广义的数据价值角度两个方面界定智慧医保的概念。其次,从智慧服务、智慧管理、智慧决策三个方面总结当前智慧医保的主要应用领域。最后,针对医保领域的重点和难点问题,从政策支撑、组织管理、数据治理、人才保障、资金保障、技术应用六个方面提出符合新时期智慧医保的发展策略,以期助力医保“决策科学化、管理精细化、服务智慧化”目标的实现。

The paper was based on the development needs of medical insurance informatization and standardization in China in the new era,focusing on the construction and development of intelligent medical insurance in the new era from the aspects of"what is it,what is to build,and how to build it".First of all,the concept of intelligent medical insurance was defined from the narrow perspective of data resource and the broad perspective of data value.Secondly,the main application fields of intelligent medical insurance were summarized from three aspects namely intelligent service,intelligent management,and intelligent decision-making.Finally,in view of the key and difficult issues in the field of medical insurance,the development strategy of intelligent medical insurance in the new era was proposed from six aspects namely policy support,organizational management,data governance,talent supply,financial security,and technology application,to help the realization of the goal of"scientific decision-making,refined management,and intelligent service"in medical insurance.