中国医疗保险
中國醫療保險
중국의료보험
CHINA HEALTH INSURANCE
2014年
2期
43-45
,共3页
医疗费用%网上预警%预警指标%医保管理
醫療費用%網上預警%預警指標%醫保管理
의료비용%망상예경%예경지표%의보관리
medical insurance expenses%online early warning%early warning indicator%medical insurance management
目前医保网上预警虽能捕捉许多异动点，但未将其串成线、连成面，缺乏对医疗保险医疗费用的综合、连续性分析能力。应根据医保医疗服务行为中各元素的内在关联建立指标体系，根据层进式预警思路设计预警系统，根据标准化需要制定预警操作流程，根据指标体系全面排查各级各类指标，根据费用发生不同特点适时调整阈值。
目前醫保網上預警雖能捕捉許多異動點，但未將其串成線、連成麵，缺乏對醫療保險醫療費用的綜閤、連續性分析能力。應根據醫保醫療服務行為中各元素的內在關聯建立指標體繫，根據層進式預警思路設計預警繫統，根據標準化需要製定預警操作流程，根據指標體繫全麵排查各級各類指標，根據費用髮生不同特點適時調整閾值。
목전의보망상예경수능포착허다이동점，단미장기천성선、련성면，결핍대의료보험의료비용적종합、련속성분석능력。응근거의보의료복무행위중각원소적내재관련건립지표체계，근거층진식예경사로설계예경계통，근거표준화수요제정예경조작류정，근거지표체계전면배사각급각류지표，근거비용발생불동특점괄시조정역치。
The current medical insurance online early warning system can capture many change points. Due to lack of comprehensive and constant analysis ability on medical insurance expenses, they cannot be stringed into a line, and further into a surface. We should establish the index system according to the internal relationship of each element in the medical service behavior, design the early warning system according to the thought of layer type early warning system, establish the early warning procedures according to the standardization needs, conduct a comprehensive investigation with various indicators in the index system, adjust the threshold according to the different characteristics of expenses.
