CAJ | 학술논문

医疗行业是一个受国家政策影响较大并有很强专业性的特殊行业,经常会因国家政策变动而影响医疗流程.费用结算系统体现的医院对现金流的管理其业务流程相对简单,一旦与医疗业务联系过于紧密,其业务流程将变得非常复杂.在外部随着医保的普及,医保管理机构要求医院费用结算系统必须与医保系统进行实时在线交易,而各地医保政策、技术方案不尽相同并且出现同一地区存在多套医保结算系统,医院费用结算系统需同时与多个医保系统实现对接.通过对现就诊业务的分析,费用结算系统不应是医院管理系统核心组织者,所有与医疗行为相关的业务应该从结算系统中分离出来.结算系统唯一的职责是为其他了系统提供费用结算服务,并为相关的业务系统提供结算清单作为业务继续的费用凭证.
의료행업시일개수국가정책영향교대병유흔강전업성적특수행업,경상회인국가정책변동이영향의료류정.비용결산계통체현적의원대현금류적관리기업무류정상대간단,일단여의료업무련계과우긴밀,기업무류정장변득비상복잡.재외부수착의보적보급,의보관리궤구요구의원비용결산계통필수여의보계통진행실시재선교역,이각지의보정책、기술방안불진상동병차출현동일지구존재다투의보결산계통,의원비용결산계통수동시여다개의보계통실현대접.통과대현취진업무적분석,비용결산계통불응시의원관리계통핵심조직자,소유여의료행위상관적업무응해종결산계통중분리출래.결산계통유일적직책시위기타료계통제공비용결산복무,병위상관적업무계통제공결산청단작위업무계속적비용빙증.
The healthcare industry is a very special professional industry which can be easily affected by national policies and the medical process is often affected by fluctuations in national policies. The expense settlement system reflects that a hospital has a rather simple cash flow management process. But once it is closely connected to medical services, the process will become very complex. As the health insurance becomes more and more popular, the health insurance management authority requires that a hos-pital's expense settlement system must be consistent with health insurance system and real-time online transaction is available for both. While the health insurance policy and technical solution vary in different areas and there may exists multiple health insur-ance settlement systems in the same area, a hospital's expense settlement system needs a channel to connect with multiple health insurance systems. Through the analysis of current patient treatment service, the expense settlement system should not be the core of the hospital management system and all the services related to medical treatment should be separated from the settlement sys-tem. The settlement system's sole purpose is to provide expense settlement service for other systems,and provide settlement list as the payment voucher for follow-up services after the settlement is done.