按疾病诊断相关分组付费模式下医保监管系统设计  

Design of the Medical Insurance Supervision System Based on Diagnosis Related Groups Payment Mode

作　　者：郝倩 章平 HAO Qian;ZHANG Ping(Hangzhou Medical College,Hangzhou310013,China;Zhjiang University,Hangzhou310058,China)

机构地区：[1]杭州医学院,杭州310013 [2]浙江大学,杭州310058

出　　处：《医学信息学杂志》2022年第6期72-77,共6页Journal of Medical Informatics

基　　金：浙江省科学技术厅软科学研究计划项目“浙江医保病组支付系统的实施路径和机制优化研究”(项目编号:2021C35106);浙江省医学科学院研究计划项目(项目编号:00004AC62010Q04)。

摘　　要：阐述按疾病诊断相关分组(Diagnosis Related Groups,DRG)付费模式下医保监管系统建设目标、具体需求、技术架构、人工智能应用、监管服务主题及功能展现,指出该系统有助于实现覆盖DRG基金结算全流程的医保基金智能监控,提升医保机构治理能力。The paper expounds the medical insurance supervision system based on Diagnosis Related Groups(DRG) payment mode from the aspects of construction objectives,concrete requirements,technical architecture,application of Artificial Intelligence(AI),supervision service themes and function presentation,and points out that the system is conducive to realize the intelligent monitoring of medical insurance funds covering the whole process of DRG fund settlement,and improve the governance capacity of medical insurance institutions.

关 键 词：知识图谱 大数据 按疾病诊断相关分组付费 医保监管 系统设计 

分 类 号：R-058[医药卫生]