中国医疗保险
中國醫療保險
중국의료보험
CHINA HEALTH INSURANCE
2013年
7期
25-29
,共5页
医疗保险%数据分析%费用稽查%运用
醫療保險%數據分析%費用稽查%運用
의료보험%수거분석%비용계사%운용
medical Insurance%data Analysis%expenses supervision%application
数据分析对于准确锁定医疗费用稽查对象,搜集稽查证据,形成稽查意见有着十分重要的作用。2012年,福州市医保通过多种方法的数据分析,提升了稽查效率和质量,共剔除违规金额1400多万元,约占全年基金支出的1.17%。但数据分析要把握信息的充分性、信息资料的相关性和分析方法的系统性问题。
數據分析對于準確鎖定醫療費用稽查對象,搜集稽查證據,形成稽查意見有著十分重要的作用。2012年,福州市醫保通過多種方法的數據分析,提升瞭稽查效率和質量,共剔除違規金額1400多萬元,約佔全年基金支齣的1.17%。但數據分析要把握信息的充分性、信息資料的相關性和分析方法的繫統性問題。
수거분석대우준학쇄정의료비용계사대상,수집계사증거,형성계사의견유착십분중요적작용。2012년,복주시의보통과다충방법적수거분석,제승료계사효솔화질량,공척제위규금액1400다만원,약점전년기금지출적1.17%。단수거분석요파악신식적충분성、신식자료적상관성화분석방법적계통성문제。
Data analysis plays an important role in accurately locating the medicare expenses supervision objects, collecting proofs, and finally coming to a supervision conclusion. In 2012, Fuzhou Medical Insurance Management Center enhanced the supervision efficiency and quality through data analysis in many ways. Over 14 million RMB involved was eliminated, which occupied 1.17% of the yearly fund expenditure. In summary, data analysis relies on the sufficiency, relativity of information as well as the systematization of the analytic methods.