Research on the construction and improvement strategies of the intelligent medical insurance monito-ring system in large public hospitals in Guangzhou city
10.3969/j.issn.1671-332X.2024.06.028
- VernacularTitle:广州市大型公立医院医保智能监控体系的构建与提升策略研究
- Author:
Xiaorong CHEN
1
;
Xueying HUANG
;
Jingcheng LI
;
Guansheng HE
;
Weijun MIAO
Author Information
1. 广州医科大学附属第二医院 广东广州 510260
- Keywords:
Public hospital;
Health insurance;
Intelligent monitoring;
Construction;
Strategy;
Collaborative management
- From:
Modern Hospital
2024;24(6):921-924,927
- CountryChina
- Language:Chinese
-
Abstract:
With the continuous evolution and refinement of the healthcare insurance system,there arises a heightened de-mand for the standardization and efficacy of healthcare insurance management.This paper takes a prominent public hospital in Guangzhou City as a case study to delve into the establishment and enhancement of an intelligent monitoring system for healthcare insurance.Initially,an analysis is conducted from the perspectives of the national,policy,and institutional levels to underscore the imperative and urgency of constructing an intelligent monitoring system for healthcare insurance.Subsequently,a comprehen-sive review of the current research landscape,both domestically and internationally,is presented,highlighting the challenges faced by domestic intelligent auditing systems in terms of their level of intelligence,the sophistication of hospital-level intelligent monitoring,and the standardization of rule libraries.Following this,the paper elaborates on the practical endeavors undertaken by large public hospitals in Guangzhou City regarding the construction and optimization of the intelligent monitoring system for healthcare insurance.This encompasses aspects such as the structure of the intelligent monitoring system,collaborative manage-ment in operational modes,and the standardization of rule libraries.Finally,the paper concludes by summarizing the positive im-pact of these practices on the regulation of medical service behaviors and the enhancement of efficiency in healthcare insurance quality management,while also offering insights into future research directions.
