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论文编号：	5129
作者编号：	2220100996
上传时间：	2013/5/29 5:14:20
中文题目：	301医院医保信息管理平台建设研究
英文题目：	Investigation of medical insurance information management platform construction
指导老师：	戚安邦
中文关键字：	医疗保险 管理 信息化
英文关键字：	medical insurance management information
中文摘要：	随着我国城乡居民基本医疗保险的全面覆盖，对医院医保管理服务水平提出了更高的要求，医院医保管理存在的问题和不足逐渐暴露出来，需要快速有效的解决。通过研发301医院医保信息管理平台，整合医院HIS系统和医保业务组件的数据，能让医院管理者在第一时间了解医院医保费用情况，及时对医院医保管理工作进行调整，能让临床医务工作者了解科室医保患者费用发生情况，能更好的辅助医政管理和物价管理，优化管理事务流程。 301医院医保信息管理平台主要包括三部分的内容。一是开发医保费用电子化审核系统，实现对医保费用项目的电子化审核。二是统计分析医院内部信息系统的医保数据，包括住院医保患者费用总体情况、按病区了解某时间段全院医保人员费用情况、统计某时间段各病区某项费用类别医保费用情况等内容。三是统计分析首信医保报表系统的医保数据，包括实时监控、数据统计、医保政策、数据维护等内容。医院端医保信息管理平台的研究将开创院端医保信息化研究的先河。一是电子化审核系统，结束审核人员手工审核的历史，优化审核流程，方便患者，提高结算效率，也为审核工作的前移奠定基础。二是信息分析统计系统结束医保数据没有固定数据库的历史，工作人员可及时准确的发现异常数据，并管控，提高管理效率。三是信息分析统计系统使本研究倡导的走临床路线、为科室服务的理念得以实施，拉近医保与临床的距离，真正做到医保就在临床身边。
英文摘要：	Hospital is the important carrier to carry out polity and regulation of medical insurance. With the development of medical insurance, the problems have been emerging and rapid and efficient solve method was needed. The first of the main problem is that the new medical insurance policy has been updating fast. The second is that hospital coordinated difficultly the data from medical insurance management center. The third is that reference range of medical insurance outcome is wide. The fourth is that emphasis of hospital management changed with the transformation of medical insurance pay mode. Medical insurance information platform was investigated to coordinate the data of HIS system and medical insurance service component. The hospital managers can supervise the situation of medical insurance cost in the first time and improve the manner of management in time. There are three parts. The first is to develop medical insurance electronic auditing system. The second is to statistically analysis HIS medical insurance data. The third is to statistically analysis the medical insurance data in medical insurance service component. Medical insurance information platform create the first attempt of hospital medical insurance information investigation. Firstly, electronic examination and verify system finish the history of handmade record and adjustment. Secondly, the hospital staffs can analysis important medical insurance data with the information analysis and statistic system. Thirdly, the application of information system has make the medical insurance information management and clinical work supporting each other. Fourthly, clinical pathway mode motivated by cost control could be built by medical insurance information platform.
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