基于DRG付费的基金监管系统设计  

Design of a Fund Supervision System Based on DRG Payment

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作  者:方燕琴 郑毛威 谌德松 赵雨娉 Fang Yanqin;Zheng Maowei;Shen Desong;Zhao Yuping(Quzhou Medical Security Service and Management Center,Quzhou,Zhejiang 324003,China;Sichuan Jiuyuan Yinhai Software Co.,LTD)

机构地区:[1]衢州市医疗保障事业管理中心,浙江衢州324003 [2]四川久远银海软件股份有限公司

出  处:《计算机时代》2025年第1期77-80,88,共5页Computer Era

摘  要:本文探讨了基于DRG付费的基金监管系统设计,旨在通过数智化手段提升医保基金的使用效率和透明度。系统采用大数据平台技术,通过对医保大数据进行采集、处理和分析,实现覆盖DRG付费全流程的智能监控,包括病案质量监管子系统、DRG监测监管子系统和智能报告子系统。该系统已应用于衢州市的DRG业务,可辅助疑点筛查及审核过程,实现不同场景下的基金监管,有效提升了医保基金监管的科学性和精准性。This paper discusses the design of a fund supervision system based on DRG payment,aiming to enhance the efficiency and transparency of medical insurance fund utilization through digital and intelligent means.The system utilizes big data platform technology to achieve intelligent monitoring across the entire DRG payment process by collecting,processing,and analyzing medical insurance big data.This includes subsystems for medical record quality supervision,DRG monitoring and regulation,and intelligent reporting.The system has been applied to the DRG business in Quzhou City,assisting in the screening and review process of suspicious points,and realizing fund supervision under different scenarios,which effectively enhances the scientific and precise regulation of medical insurance funds.

关 键 词:DRG 基金监管 病案质量 疑点筛查 

分 类 号:TP317.4[自动化与计算机技术—计算机软件与理论]

 

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