摘要
在新时期发展背景下,患者由于病情的多样化复杂性对于检查、治疗、用药等费用差异性需求逐渐增多,而传统监管医保基金使用方法已无法满足患者的健康需求。同时,医保目录项目繁多,临床医生工作量增大,难以避免发生违反医保政策的情况,若临床医生违反医保政策,轻则面临罚款,重者将会面临吊销执业照,危害较大。为规范医生的医疗行为,引入基于Hadoop平台的医保智能分析系统,该系统利用Hadoop技术搭建大数据平台,将医保政策数据化使其适应于计算机处理,结合临床诊疗数据和医保政策数据在大数据Hadoop平台下智能分析,分析结果嵌入临床医疗系统中,提供事前预警和事后纠错。基于此,本文联系实际,为提高医疗数据利用率,高效借助计算机技术智能分析系统事前预警医保使用政策,监控医保基金使用情况,旨在为提高诊疗质量、保障医保基金的合理使用提供参考。
In the context of the development of the new era, due to the diversification and complexity of the disease,patients have gradually increased demand for different expenses such as examination, treatment, and medication, and the traditional method of using medical insurance funds has been unable to meet the health needs of patients. At the same time,there are many items in the medical insurance catalogue, and the workload of clinicians increases, which makes it difficult to avoid violations of medical insurance policies. In order to standardize the medical behavior of doctors, a medical insurance intelligent analysis system based on Hadoop platform is introduced. The system uses Hadoop technology to build a big data platform, digitizes medical insurance policies to make them suitable for computer processing, and combines clinical diagnosis and treatment data and medical insurance policy data in big data. Intelligent analysis under the Hadoop platform,the analysis results are embedded in the clinical medical system, providing pre-warning and post-error correction. In view of this, in order to improve the utilization rate of medical data, this paper effectively uses the intelligent analysis system of computer technology to warn the medical insurance use policy in advance and monitor the use of medical insurance funds,aiming to provide reference for improving the quality of diagnosis and treatment and ensuring the rational use of medical insurance funds.
作者
元伟靖
陈复兴
戴左琴
YUAN Weijing;CHEN Fuxing;DAI Zuoqin(Department of Medical,the Third People's Hospital of Jiujiang City,Jiangxi Province,Jiujiang332000,China)
出处
《中国当代医药》
CAS
2022年第36期145-147,共3页
China Modern Medicine
基金
江西省卫生健康委科技计划项目(202140223)。
关键词
HADOOP平台
医保
智能
医疗系统
Hadoop platform
Medical insurance
Intelligence
Medical system
