How does smart medical insurance construction go to "standardization"

In the era when all walks of life in the country move forward to digitalization, while carrying out a unified construction and application of medical insurance information platforms across the country, it is very necessary to think and develop the connotation and development requirements of the "ultimate goal" of "smart medical insurance". Studies in order to plan and deploy medical insurance information, digital, intelligent, and intelligent processes from a more macro and long -term perspective.

What is smart medical insurance? How to evaluate its construction content? To answer these questions, we need to define smart medical insurance and establish a quantified evaluation indicator system.

What are the characteristics of smart medical insurance?

The construction of medical security informatization is not only an indispensable basic work, but also an important means to promote the medical insurance governance system and improve medical insurance governance capabilities. In June 2020, Shi Zihai, deputy director of the National Medical Insurance Bureau, pointed out in the training course for deepening the medical security system that "digital, intelligent, and intelligent medical insurance is an irresistible trend."

In recent years, there are many "wisdom" such as "smart city", "smart environmental protection", "smart park", etc. There are many "wisdom". "Smart Medical Insurance", as a product of the development of the era, has no official or authoritative channels to give accurate definitions. And composition.

The author believes that "Smart Medical Insurance" is first to establish a precise perception of medical security. With fund revenue and expenditure and insured status as the main line, the full -scale full -process perception, identification, and judgment of the real operating data of various business nodes. After the data collection and gathering of node business, the data is cleaned and processed, and various types of "algorithms" and "models" need to be intelligently designed in accordance with the business and decision -making and decision -making to form a smart expression that combines the operation and active operation in accordance with the rules.

"Wisdom" is mainly reflected in two aspects: First, "connect", internal and business coordination units of the system should realize information interconnection, perceive interconnection, form value interconnection, and comprehensive interconnection of internal and external combination. The second is the "brain" that can continue to learn, think about self -learning, self -thinking, and provide "smart brain" for business decisions and office.

What is the definition and connotation of smart medical insurance?

In order to further clarify the connotation of smart medical insurance and clarify the direction of construction, refer to the definition of smart medical care in Baidu Encyclopedia, the author considers the definition of smart medical insurance as follows:

Using intelligent technologies and concepts such as artificial intelligence, big data, the Internet of Things, etc., in various aspects of medical insurance public services, management of medical insurance, medical insurance fund supervision, drug consumable recruitment, "three medical" sharing linkage, and elderly care services, etc. Mechanism, organizational structure, method process, means and tools to achieve comprehensive, systematic and intelligent reshaping, realize the convenience and intelligence of service, efficient collaboration, intelligent and accurate governance, collaborative sharing, support for security and reliability, and smart and reliable intelligence requirements. , Gradually change from cure to health.

According to its definition, the connotation of smart medical insurance mainly includes three aspects.

(1) Taking data as the key production factors

As the product of the development of the digital age, smart medical insurance is the intelligent decision -making and intelligent operation of "data+computing power+algorithm", which will depend more on data acquisition and processing.

The medical insurance information platforms of various provinces and cities will rely on the national medical insurance information platform and the smart city data resource centers of various provinces and cities, in accordance with the national unified medical insurance data standards, establish the national and provincial and municipal medical insurance data interaction management mechanisms, build a basic medical insurance information library and large database, form a large database, form a large database, form a large database, form a large database, form a large database, form a large database, form a large database, and form a large database. The data resource layer gradually realizes online collection, unified management and general universal medical insurance.

(2) The main production and service methods are based on cloud computing

The cloud platform is the infrastructure of smart medical insurance. It not only provides computing, storage, and network support for intelligent technology, but also a distribution center for distribution and acquisition of intelligent technology. It can better support the real -time intelligent decision -making and implementation of smart medical insurance.

The medical insurance information platforms of all provinces and municipalities are based on a unified HSAF (HealthCare Security Application Framework) technology framework construction upper application system. The business centers and big data governance centers were constructed through business Zhongtai and Data Zhongtai, and various medical insurance applications were carried out.

(3) The pursuit of service value to meet the individual needs of the people

Efficient, convenient, and real -time are the hard power that smart medical insurance serves the people's personalized medical insurance needs. Along with humans to "machine" to a certain extent, the machine's "life" interactive performance to a certain extent, the service method of human -machine interaction will become more and more common in smart medical insurance.

Especially artificial intelligence represented by voice and visual recognition technology has entered industrialization development and large -scale commercialization applications. Relying on the national unified medical insurance electronic vouchers and other means to create a service model such as electronicization, archives management and application digitalization, Provide treatment applications for various medical insurance service objects, medical insurance filing, medical insurance information query statistics, unit information maintenance and other personalized, precise and intelligent service experiences.

What is the composition of the smart medical insurance construction evaluation index system?

"Standardization" is the main way to refine the goals and directions of the wise development, and it is a "key starting point" for high -quality promoting the development of smart medical insurance. It is necessary to study and build a "standardized evaluation system for smart medical insurance" from a more macro evaluation and control perspective.

The construction of the standardized evaluation system is a more complex system project. It needs to be set up from a multi -level evaluation dimension (first, second, third, third, etc.), including the setting of evaluation indicators, the calculation method of the evaluation indicator, the evaluation implementation method, etc. At the level. The Smart Medical Insurance Construction Evaluation Index System is shown in Table 1. Table 1 Smart Medical Insurance Construction Evaluation Index System

At this stage, the construction of basic platforms, the collection and utilization rate of data resources, the onlineization of services, the integrated synergy and intelligent supervision of the service, etc. Focus on consideration.

At the level of the index setting method, the requirements of the MECE principles (independent, complete and exhausting), operating principles, typical principles, quantifiable principles, dynamic principles, etc. need to be comprehensively considered.

From the perspective of practical experience, the construction of a successful "standardized evaluation system" needs to go through a dynamic process of "research -implementation -optimization and upgrade".

In the early days of construction, the systemic and execution requirements of "implementation strategy" are often more important than the scientific and rationality of the "evaluation system" itself. Therefore, it is necessary to carry out thorough planning and layout of the guarantee mechanism, publicity mechanism, evaluation mode, evaluation cycle settings, and evaluation methods.

Taking smart services as an example, refinement and analysis of the reference and evaluation methods of each indicator are shown in Table 2.

Table 2 Reference and evaluation method of smart service indicators

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