Xiamen: Wisdom medical insurance system to create a sample of information control fees
One day at the end of March 2016, OFweek Medical Network, Dr. Guan Tianjun showed the practical application of smart medical insurance to the reporter at the Department of Nephrology, Zhongshan Hospital, Xiamen University. Guan Tianjun said that before the application of smart medical insurance, doctors can't grasp the same kind of drugs that the same insured person can open the same kind of drugs in different medical institutions. After the medical insurance is on the line, you can clearly know the remaining dose of the insured and the number of outpatient visits, and effectively prevent it. Medicine mouse."
Wisdom medical insurance also has a reminder function in the event (after the doctor prescribes the prescription, before the settlement), and the pre-existing reminder function constitutes a platform to pay attention to the "real-time reminder" system for preventing the problem, that is, the behavior of the diagnosis and treatment of suspected violations, to the medical staff, the designated institution and the reference The real-time warning of the guarantor has enabled many doctors to avoid passive or active violations caused by human circumstances.
Smart medical insurance
Wisdom medical insurance was officially launched in April 2014. It has been fully deployed in Xiamen's designated medical institutions. A total of 522 medical institutions have been opened, connecting 7346 doctor workstations, and seamlessly connecting with 99.06% of doctor workstations in Xiamen.
Wisdom medical insurance services for management, according to management services, mainly have five application systems, real-time reminder system based on prevention (pre-existing and reminding in the event), data mining-based stratified analysis system, risk control-based Comprehensive evaluation system, intelligent audit system for post-audit review and integrity management system for integrity records. Among them, the real-time reminding system, the intelligent auditing system, and the integrity management system have been officially launched, and the initial utility has been exerted in the supervision work; the layered analysis system and the comprehensive evaluation system have been put into the line and are still in the process of improvement.
Significant control effect
Lin Quanshui, deputy director of the Human Resources and Social Security Bureau of Xiamen, said that smart medical insurance is the professional service capability and talent advantage of Xiamen commercial insurance company, combined with Xiamen's many years of medical monitoring practice experience and advanced concepts, by Ping An Pension Insurance Co., Ltd. Headquarters mobilized system-wide resources for independent research and development, the main purpose is to solve the two problems of “medical insurance fund risk control†and “expensive medical treatment†that have plagued the medical insurance department for many years, and realized the screening and monitoring of waste, abuse and fraudulent medical insurance fund behavior. The tentacles of supervision extend to specific medical service behaviors, which promotes the transformation and upgrading of medical insurance supervision methods from ex post investigation to ex ante prevention and in-process control. It is an effective practice of PPP mode.
The data shows that since its inception, as of December 31, 2015, the smart medical insurance rules triggered 1.06 million times, of which 1.04 million were reminded beforehand, the effective reminding rate reached 89.51%, and the effective prevention of 93 million people has 30 days remaining. There are still violations of the intention to overtake drugs; 16740 audits were conducted in the event, effectively blocking 7043 problem documents, and a large number of violations were imposed before the expenses occurred. The increase in medical expenses for credit card in Xiamen City decreased by 0.58% year-on-year, and the cost expenditure was reduced by 31.239 million yuan. Among them, the increase in medical expenses for card medical insurance decreased by 1.00% year-on-year, and the cost expenditure was reduced by 4,702,380 yuan. The phenomenon of drug-opening tends to decrease, and the outpatient service in the city focuses on drugs. The cost reduction expenditure was 26.45 million yuan.
Compared with the July and December 2015 data, the total number of violations and the costs involved are gradually reduced, including the use of special diseases, children's use of drugs, non-indications, ultra-short-term hospitalization, surgical grade management, etc. 6,680,500 yuan, the number of suspected illegal documents decreased by 83,029.
According to the investigation of the medical and health department of the People's Liberation Army 174 Hospital and the outpatient doctor of the Zhongshan Hospital affiliated to Xiamen University, the overall operation of the system was stable and the doctors approved the medical insurance audit results. Not only that, Li Yongzhong, deputy dean of Zhongshan Hospital affiliated to Xiamen University, told reporters that the platform is very popular with doctors and that after its application, it has great benefits. Before the doctors needed to check the prescriptions, they knew that the medications were systematically monitored. When I found out that there was a problem, I would like to respond, and I suddenly blocked the "doctors opening drugs."
Gao Jing, general manager of Ping An Pension, said that commercial insurance companies, whether they are handling major illness insurance or operating supplementary medical insurance, are paid after the basic medical insurance claims, so the basic medical insurance claims are well controlled, medical expenses are used reasonably, and business It is helpful to reduce the cost of insurance companies.
In fact, the beneficiaries who improve the efficiency of the use of medical insurance funds are undoubtedly the insured persons who really need them. Through the extension and expansion of the functions of the platform service program, the insured personnel can obtain accurate, safe, reliable, efficient and convenient when they seek medical treatment. Service experience, alleviating the dilemma of "difficult to see a doctor, expensive to see a doctor."
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Phenytoin is a "brain stimulant" that has a variety of effects on the body and nervous system. A telepath is a drug that enhances memory or stimulates a specific area of the brain. It is also used to treat conditions such as anxiety and insomnia and people with generalized anxiety disorder (GAD) may benefit from taking Fenebute. The drug of the technical name for beta - phenyl - gamma-aminobutyric acid, it is a kind of the gamma-aminobutyric acid derivatives nervous system regulator, GABA (and its derivatives, such as phenytoin sodium) has proven to have some effect, make these chemicals for the treatment of some useful not bout is a kind of promote medicine, sometimes used in the treatment of anxiety disorders, The drug was originally an "astronaut's drug".
The report cites the I.M. Herzen-Leningrad Institute in the former Soviet Union as one of the earliest sites for synthesizing phenytoin. Russian space explorers took the form of this chemical to help them deal with the need for fenebbut to treat insomnia and in modern medicine, phenobarbital has lowered blood pressure and other related effects. It has some side effects, including the effects of drug withdrawal, increased blood pressure, anxiety and insomnia. Researchers are still studying how drugs like Fennebute can help better control neurological conditions.
Due to its side effects, fenibute should not be taken first by consulting a doctor. Doctors sometimes use the drug to treat post-traumatic stress disorder in military personnel and other patients. It's also prescribed by doctors for people with specific symptoms a kind of anxiety, including social anxiety. It could even help treat other conditions, such as stuttering. In forums related to these conditions and pharmacology, individuals are attempting to educate the public about medicines. Before starting treatment with Fenebute or related medications, patients must be aware of the risks and benefits.
Consumer advocates point out that not all popular uses of these drugs have been specifically approved by the FDA, and that more attention may need to be paid to clinical trials. Government medical information sources have provided more information about the pharmacology of phenytoin sodium and information about the drug has reached the fitness community. Some people apparently believe that benibute is useful for athletes because of its relaxing properties. Fitness forums include reviews of the drug from individual users, including those who buy it over the counter. Although similar drugs are also available over the counter, individuals should seek medical attention before taking them due to reported side effects. As with Benibute, exercise can help reduce the symptoms of anxiety.
What is Phenibut?
Phenytoin is a "brain stimulant" that has a variety of effects on the body and nervous system. A telepath is a drug that enhances memory or stimulates a specific area of the brain. It is also used to treat conditions such as anxiety and insomnia and people with generalized anxiety disorder (GAD) may benefit from taking Fenebute. The drug of the technical name for beta - phenyl - gamma-aminobutyric acid, it is a kind of the gamma-aminobutyric acid derivatives nervous system regulator, GABA (and its derivatives, such as phenytoin sodium) has proven to have some effect, make these chemicals for the treatment of some useful not bout is a kind of promote medicine, sometimes used in the treatment of anxiety disorders, The drug was originally an "astronaut's drug".
The report cites the I.M. Herzen-Leningrad Institute in the former Soviet Union as one of the earliest sites for synthesizing phenytoin. Russian space explorers took the form of this chemical to help them deal with the need for fenebbut to treat insomnia and in modern medicine, phenobarbital has lowered blood pressure and other related effects. It has some side effects, including the effects of drug withdrawal, increased blood pressure, anxiety and insomnia. Researchers are still studying how drugs like Fennebute can help better control neurological conditions.
Due to its side effects, fenibute should not be taken first by consulting a doctor. Doctors sometimes use the drug to treat post-traumatic stress disorder in military personnel and other patients. It's also prescribed by doctors for people with specific symptoms a kind of anxiety, including social anxiety. It could even help treat other conditions, such as stuttering. In forums related to these conditions and pharmacology, individuals are attempting to educate the public about medicines. Before starting treatment with Fenebute or related medications, patients must be aware of the risks and benefits.
Consumer advocates point out that not all popular uses of these drugs have been specifically approved by the FDA, and that more attention may need to be paid to clinical trials. Government medical information sources have provided more information about the pharmacology of phenytoin sodium and information about the drug has reached the fitness community. Some people apparently believe that benibute is useful for athletes because of its relaxing properties. Fitness forums include reviews of the drug from individual users, including those who buy it over the counter. Although similar drugs are also available over the counter, individuals should seek medical attention before taking them due to reported side effects. As with Benibute, exercise can help reduce the symptoms of anxiety.
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