医保智能监控系统知识库、规则库建设的分析研究  

Analysis on the Construction of Knowledge Database and Rule Database for Healthcare Fund Intelligent Auditing and Monitoring System

作　　者：段秀秀 

机构地区：[1]《中国医疗保险》杂志社,北京100037

出　　处：《中国医疗保险》2022年第9期88-93,共6页China Health Insurance

摘　　要：医保基金智能审核和监控知识库、规则库是实现医保基金智能监管的核心技术支撑,医保部门依托“两库”,对各类监管对象进行全流程监控。本文梳理“两库”概念的内涵和外延、功能定位,介绍“两库”建设的典型经验,分析现阶段“两库”建设存在的数据采集和标准化困难、一体化管理困难等问题,提出实施分级管理机制等完善建议,以期为全面建立智能监控制度提供借鉴。Construction of the knowledge databases and rule database is the fundamental to the intelligent supervision of medical insurance funds.Relying on the“two databases”,the healthcare administration can monitors the whole procedure of all parties involved.The paper illustrates the connotation,extension and function of the"two databases",introduces the typical local experience,analyzes the difficulties in data collection and standardization,integrated management and other problems at the current stage,and puts forward improvement suggestions such as implementing hierarchical management mechanism,providing reference for the comprehensive establishment of intelligent monitoring system.

关 键 词：知识库 规则库 智能监控 基金监管 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]