摘要
文章通过对我国医保监管存在问题以及医保医用耗材代码的应用及其医用耗材合理使用医保闭环监管的运用可行性进行分析,探讨针对医保医用耗材代码运用场景,跨机构、跨平台的医用耗材全流程闭环监管的重要性,医用耗材采购使用行为全流程跨平台串联的可行性进行分析,进而提出通过医保医用耗材代码对各平台数据库进行映射管理,完成对医保部门、省级医药集中采购平台以及医疗机构进行跨平台、跨机构形成数据互联互通,并完成对医用耗材采购、使用形成“事前预警,事中干预,事后评价”全流程闭环监管,有效促进医用耗材的合理使用,从而更进一步促使医保基金合理运用。
This article analyzes the problems in China's medical insurance supervision,the use of medical consumables coding and the feasibility of using medical insurance closed-loop supervision for the rational use of medical consumables.It explores the importance of cross institutional and cross platform closed-loop supervision of medical consumables throughout the entire process,and the feasibility of connecting the entire process and platform of medical consumables procurement and use behavior,Furthermore,it is proposed to map and manage the databases of various platforms through the coding of medical consumables for medical insurance,and to achieve cross platform and cross institutional data interconnection between medical insurance departments,provincial pharmaceutical centralized procurement platform,and medical institutions.The procurement and use of medical consumables are also monitored in a closed-loop manner that includes"pre warning,intervention during the process,and post evaluation",effectively promoting the rational use of medical consumables,thus further promoting the rational use of medical insurance funds.
作者
蒋尹渝
梅强
王钰麟
龚顺军
JIANG Yinyu;MEI Qiang;WANG Yulin;GONG Shunjun(Department of Medical Consumables Trading,Chongqing Medicine Exchange Co.,Ltd.,Chongqing 401100,China)
出处
《中国卫生标准管理》
2024年第10期11-14,共4页
China Health Standard Management
基金
重庆市技术创新与运用发展专项面上项目(CSTB2022TIAD-GPX0070)。
关键词
医保医用耗材代码
闭环管理
医保基金
监管
采购
合理使用
medical insurance medical consumables code
closed-loop management
medical insurance fund
supervision
procurement
reasonable use
