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With the explosive growth of " City-customized Medical Insurance" products, the voice of commercial health insurance needs medical insurance data support is increasing.The authors took " City-customized Medical Insurance" as the representative of commercial health insurance, analyzed the demands and motivations of stakeholders in medical insurance data sharing through the power-interest matrix model, and summarized the medical insurance data sharing path at the commercial insurance product design end and claim settlement end. It is suggested to strengthen the top-level design, build the implementation path of standardized sharing of medical insurance data and the operation mechanism of hospital data docking, to realize the value increment of all stakeholders.
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Objective:To analyze the health development plans of the provinces in China during the " 14th Five-Year Plan" , and explore the key tasks, similarities and differences of health informatization construction in each province.Methods:Using the website of local people′s government and the official website of the provincial Health Commission, 27 copies of health development plans of various provinces during the " 14th Five-Year Plan" period were retrieved and collected from February 16 to June 5, 2022. The relevant statements of health information in the plan were extracted, content analysis was used to reveal the structural characteristics of the policy in the form of word frequency statistics, and discourse analysis was used to study the policy content.Results:The health information policies of 27 provinces during the " 14th Five-Year Plan" period could be summarized as 10 major themes, such as accelerating the construction of hierarchical diagnosis and treatment system, promoting the high-quality development of public hospitals, and deepening the reform of medical security system. The health information policy in the eastern, central and western regions was relatively clear, and there were certain differences in the construction points according to their own characteristics.Conclusions:During the " 14th Five-Year Plan" period, the policies of each province around the field of health information are well defined, and the core structure and content are similar. The distribution of key points in the eastern region is relatively balanced; the construction of health information in the central region is more prioritized and prominent; the construction of health information in the western region is focused on complementing the weak links and weaknesses.
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After recent years′ development, China′s Internet medical service and medical insurance policy system has begun to take shape, but it still needs to be further improved. By combing the connotation and mode of Internet medical services, the evolution of medical insurance payment system and the content of medical insurance payment policy in the United States, the authors put forward that China could further improve the medical insurance payment policy system of Internet medical care, strengthen the multi-point practice management of licensed doctors on the Internet, give full play to the role of commercial insurance in promoting Internet medical care, and rely on information technology means to improve the medical insurance supervision of Internet medical services, then promote the development and management of Internet medical insurance services in China.
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Objective:To analyze the filing mechanism for cross provincial immediate reimbursement of medical insurance in China, so as to provide reference for optimizing the filing mechanism and improving the filing accessibility of insured personnel.Methods:Taking the filing policy of cross provincial immediate reimbursement of medical insurance in 2019 as the research object, on the basis of a comprehensive understanding of the national filing policy background, 90 coordinating regions in Zhejiang Province, Hubei Province and Ningxia Hui Autonomous Region were taken as survey samples to evaluate the relevant policies and extract key parameters, including filing identification methods, filing-related settlement benefits and filing ways. The parameters were compared and analyzed by using descriptive statistical methods.Results:The results of the survey showed that in terms of identity recognition methods, the provision of various supporting materials(residence permit, work certificate, etc.)was still the main way to carry out identity recognition for medical insured persons in different places.Filing-related reimbursement benefits were mainly adjusted by limiting the area of medical insurance treatment and adjusting the benefits parameters(reimbursement ratio). In terms of filing channels, 51(56.7%)sample co-ordination areas had realized at least one remote filing mode.Conclusions:The inclusiveness of filing identity verification mechanism for the floating population needs to be further improved, the filing-related treatment policies need to be further improved, and the convenience and standardization of filing channels need to be strengthened.
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Objective:To provide a reference for establishing the evaluation system of the implementation effect of cross provincial direct settlement policy.Methods:By referring to the public policy evaluation model and using the expert consultation method, the authors built an evaluation index system for the implementation effect of cross provincial direct settlement policy for urban and rural residents. The multi-attribute group decision-making analytic hierarchy process, Matlab software and Yaahp software, combined with Spearman correlation coefficient method, were used to cluster the expert opinions and further determine the weight of each element at different levels.Results:The evaluation index system of the implementation effect of direct settlement policy for urban and rural residents′ cross provincial medical insurance was constructed, including 3 first-class indicators, 9 second-class indicators and 20 third-class indicators, and the weight of each index was calculated.Conclusions:The designed index system is suitable for grasping the implementation level of the cross provincial direct settlement policy from a macro perspective, and find out the problems in the implementation process. Efforts should be made to refine the evaluation criteria of the indicators in the index system.
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The present use of artificial intelligence at primary health care institutions covers auxiliary treatment, voice electronic medical records, rational drug use, chronic disease management assistance, and auxiliary diagnosis of medical images. The authors analyzed the main factors restricting the development of primary medical artificial intelligence products, and put forward solutions from the perspectives of optimizing product functions, organizing expert resources from the national level. These efforts can assist in the examination and approval of medical artificial intelligence products, and improve the medical artificial intelligence system, so as to promote the healthy and sustainable development of artificial intelligence in primary medical and health institutions.
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This paper defined the main stakeholders of basic medical insurance mobile payment using the stakeholder theory, namely the government ( medical insurance bureaus, human resources and social insurance authorities, and healthcare regulators ), medical insurance agencies, pilot hospitals, medical workers, patients, and third-party social resources ( third-party payment entities, commercial insurers, web-based medical enterprises, and state-own financial institutions). SWOT analysis is used in analysis of stakeholders, to uncover the strength, weakness, opportunity and threats in advancing basic medical insurance mobile payment, thereby proposing how to guarantee the healthy and sustainable development of such mobile payment.
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The classification of social capital involved in health information construction was proposed according to the connotation of social capital and health information construction, and the comprehensiveness, broadness, coop-erative variety, innovative technical application and good development situation of social capital involved in health information construction were dealt with.
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After a description of the background of hierarchical diagnosis and treatment in China, the total frame-work of hierarchical diagnosis and treatment system in the Internet+era was proposed by analyzing its needs in the Internet+ era, and the main functions of its data center, information system, clinical professional collaboration and public health service were elaborated in order to promote medical health actions and construction of hierarchical diagnosis and treatment system in China.
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Construction of regional health information sharing in the United States, Britain and Canada is introduced and analyzed, which include organizational structure, strategic planning, technical infrastructure, operation model, implementation mode and develop-ment characteristics.According to the status of regional health information sharing construction and problems existed in China, the paper put forward relevant suggestions combined with the construction experience of these countries.
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〔Abstract〕 In order to advance the comprehensive and balanced development of health and family planning informatization in Beijing on the whole, according to the theoretical method of top -level design and in combination with actual situations of health and family plan-ning informatization in Beijing , the paper studies practices on top -level design from the aspect of technical routes and organization and implementation, and elaborates achievements of top -level design.
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After the concepts of electronic health records were described , the construction of service system for sharing electronic health records in some major foreign countries was analyzed in aspects of their organizations , poli-cies and laws, criteria for data sharing, data security and privacy protection, with suggestions put forward for the construction of service systems for sharing electronic health records in China, such as speeding up the transforma-tion of governmental management functions , strengthening the guidance for health information construction at macro level, establishing the criteria for data sharing, improving the legal system construction, and attaching importance to privacy protection .
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With the intensification of population floating in China, there has been a growing demand for ecdemic medical care. Because basic medical insurance in China conduct localized management, the differentiation between reimbursement policy and level in different areas result in the difficulty of immediate settlement. The great quantity of floating population are faced with rather heavy personal burden when need medical care at different locations, which to some extent restrict in-time healthcare for floating population. On the basis of analyzing the features of endemic medical care for floating population, it described three mode of typical immediate settlement on ecdemic medical care, discussed the main problems in restricting the flowing population get immediate settlement at different locations and put forward suggestions on improving the immediate settlement at different locations.