中国医疗保险
中國醫療保險
중국의료보험
CHINA HEALTH INSURANCE
2015年
7期
12-14
,共3页
医疗保险%医疗服务治理%智能审核
醫療保險%醫療服務治理%智能審覈
의료보험%의료복무치리%지능심핵
health insurance%health service governance%intelligent auditing
长期以来，由于信息不对称，医疗保险监督机构只能站在医院门外凭借导出的数据进行控费，无法与医生对话。智能审核系统打开局面，引领医保监督视角走进医生工作站和患者病例并获取大数据。本文基于智能审核系统探索医疗保险在建立医疗服务治理机制过程中的引擎功能。
長期以來，由于信息不對稱，醫療保險鑑督機構隻能站在醫院門外憑藉導齣的數據進行控費，無法與醫生對話。智能審覈繫統打開跼麵，引領醫保鑑督視角走進醫生工作站和患者病例併穫取大數據。本文基于智能審覈繫統探索醫療保險在建立醫療服務治理機製過程中的引擎功能。
장기이래，유우신식불대칭，의료보험감독궤구지능참재의원문외빙차도출적수거진행공비，무법여의생대화。지능심핵계통타개국면，인령의보감독시각주진의생공작참화환자병례병획취대수거。본문기우지능심핵계통탐색의료보험재건립의료복무치리궤제과정중적인경공능。
In a long term, due to the problem of information asymmetry, medical insurance supervisors are impossible to dialogue with doctors, and they can only control medical cost by exported data. Intelligent Auditing System is of great value in leading medical insurance supervision to the process of doctor's service, and to the data of patients’ records, and in obtaining a huge number of health service data. The leading function of health insurance based on Intelligent Auditing System in the establishment of managing mechanism in medical service is explored.
