摘要
随着"惠民保"产品的井喷式增长, 商业健康保险需要医保数据支持的呼声不断增大。作者以"惠民保"产品作为商业健康保险的代表, 采用权力-利益矩阵模型分析医保数据共享利益相关者的诉求与动机, 总结了商保产品设计端和理赔端的医保数据共享路径, 并建议加强顶层设计, 构建医保数据规范共享实施路径和医疗机构高效数据对接的运行机制, 实现各利益相关者的价值增值。
With the explosive growth of"City-customized Medical Insurance"products,the voice of commercial health insurance needs medical insurance data support is increasing.The authors took"City-customized Medical Insurance"as the representative of commercial health insurance,analyzed the demands and motivations of stakeholders in medical insurance data sharing through the power-interest matrix model,and summarized the medical insurance data sharing path at the commercial insurance product design end and claim settlement end.It is suggested to strengthen the top-level design,build the implementation path of standardized sharing of medical insurance data and the operation mechanism of hospital data docking,to realize the value increment of all stakeholders.
作者
刘阳
李亚子
郭珉江
张小娟
叶媛
Liu Yang;Li Yazi;Guo Minjiang;Zhang Xiaojuan;Ye Yuan(Research Office of Health and Medical Security System,Institute of Medical Information,Chinese Academy of Medical Sciences,Beijing 100020,China)
出处
《中华医院管理杂志》
CSCD
北大核心
2022年第12期901-905,共5页
Chinese Journal of Hospital Administration
基金
国家医疗保障局基金监管司委托课题(2022033)。
关键词
保险
健康
"惠民保"
多层次医疗保障体系
医保数据共享
利益相关者
Insurance,health
"City-customized Medical Insurance"
Multi-level medical security system
Medical insurance data sharing
Stakeholder
