Using Digital Intelligence in Promoting Mechanism for Medical Care Insurance for Rare Diseases: Concepts and Applications
- VernacularTitle:数智化技术推进罕见病医疗保障机制:概念与应用
- Author:
Xinyu YANG
1
,
2
,
3
;
Yuzheng ZHANG
3
,
4
;
Shengfeng WANG
1
,
2
,
3
,
5
;
Wudong GUO
3
,
4
Author Information
- Publication Type:Journal Article
- Keywords: rare diseases; medical care insurance; digital intelligence; mechanism design
- From: JOURNAL OF RARE DISEASES 2025;4(1):30-38
- CountryChina
- Language:Chinese
-
Abstract:
Our study aims at systematically summarizing and evaluating the applications of digital intelligence technologies in the field of rare disease medical care insurance now and in the future and at constructing a conceptual framework for the digital powered mechanism for the medical care insurance for rare diseases. By using Chinese keywords of " rare disease" " medical insurance"" artificial intelligence"" prediction model"" machine learning"" big data"" algorithm" and their English equivalents, we searched the databases of PubMed, Embase, Web of Science, CNKI, Wanfang, and VIP, collected relevant literature, and decided the criteria of inclusion and exclusion. The finding of our study shows that medical care insurance mechanism of rare disease in China faces significant challenges in drug accessbility and the funding sustainability. Meanwhile, our study shows that the digital intelligence technologies have broad potential in applications-in financing, accessbility, payment, and supervision. Specifically, dynamic simulation models and big data analysis can make precise prediction of the demand for funding of medical care insurance. The machine learning algorithms improve the dynamic evaluation of drug safety and cost-effectiveness. The personalized payment models enhance the efficiency in identifying the cohort with high expenditure so as to alleviate fund expenditure pressures. The intelligent monitoring technologies can accurately detect the abnormal behaviors in funds of medical care insurance. These technologies provide systematic and scientific solutions for improving the medical care mechanism for rare diseases. Even though further investigation is needed, the digital intelligence technologies have shown remarkable potential in enhancing the flexibility, efficiency, and sustainability of the medical care insurance system and a promising future in meeting the needs of patients with rare diseases.