On September 1 day, it was learned from the Provincial Department of Human Resources and Social Security that in order to curb the unreasonable growth of medical expenses and improve the utilization efficiency of medical insurance funds, the basic medical insurance medical service supervision information system was deployed and built in our province to supervise the medical services of medical institutions in real time, and the unified centralized "one network" model was the first in China. Before the end of the year, the provincial level and eight cities should realize the online operation of the supervision system, and the rest of the cities should realize the online operation of the supervision system before the end of 20 16.
Recently, the audit department of a city in our province found that the hospitalization expenses of 12 county-level public hospitals in this city did not fall, but rose. Looking at the whole province, at present, the management of medical insurance funds in our province is distributed at the provincial, municipal and county levels, and the problems of leakage and fraud still exist. At present, the income growth of medical insurance fund is obviously slowing down, but the medical expenses are increasing at a high speed, so it is urgent to monitor the unreasonable expenditure of medical expenses.
"Gradually establish a real-time monitoring system for basic medical services, which is required by the central government and necessary for work." Cui Jingjian, director of the Provincial Human Resources and Social Security Information Center, told the reporter that at present, the number of people participating in medical insurance in the province has reached more than 90 million, and only at the provincial level, more than 80,000 medical insurance settlement data are generated every day, and the number of new medical insurance data in the province is not less than 6,543,800. Simply relying on traditional manual methods can no longer meet the regulatory analysis. "The era of big data requires us to make full use of information technology."
It is reported that our province officially started this work in early March this year, and has now entered the stage of deployment and construction. The medical service supervision information system of our province's basic medical insurance adopts the provincial centralized construction mode, applies the mature medical service intelligent audit technology, adopts the "modular" cooperation mode, localizes the medical knowledge base and the audit rule model, and combines it with the current social insurance core platform system in our province. The province has formulated more than 40 monitoring rules. The medical service information of designated medical institutions and medical personnel and the medical purchase information of the insured are included in the monitoring scope. Through this system, illegal and suspicious documents are automatically screened, which reduces manual operation and improves audit efficiency.
Another highlight of this system in our province is the gradual transition from post-audit to in-process monitoring, early warning and early warning. "If the doctor has some improper operations when prescribing medicine, he will receive a system reminder to prevent problems before they happen." Cui Jingjian said.
According to the deployment, at the provincial level, Zaozhuang, Weifang, Jining, Tai 'an, Laiwu, Dezhou, Binzhou and Heze are the first areas to start the medical insurance supervision system, and the supervision system should be put into operation before the end of the year. Jinan, Qingdao, Zibo, Dongying, Yantai, Weihai, Rizhao, Linyi and Liaocheng are the second batch of start-up areas. In the early stage, this system first operated in some designated medical institutions, and gradually realized the full coverage of medical insurance in all designated medical institutions in the future.
The above is what Bian Xiao shared about "big data" blocking the medical insurance fund. For more information, you can pay attention to the global ivy and share more dry goods.