DRGs payment and medical big data jointly promote commercial insurance to take off
The promotion of DRGs payment method exceeded expectations, and the corresponding hospital-side application software informatization manufacturers will benefit greatly: since the new medical reform, the human and social departments have clearly proposed to combine the outpatient consultation on the basis of total control to carry out per capita payment, combined with the guarantee of hospitalization. Explore a multi-disciplinary payment system that pays by case (DRG), pay-per-view, and pay-per-service. This policy clearly requires that the payment criteria for the payment of single disease types and the payment methods of the disease-related diagnosis group (ie, DRGs payment) through the clinical path will promote the progress of the DRGs payment method from the pilot stage to the nationwide application. The hospital-side application software with DRGs group as the core, including the performance analysis, quality control, process control (clinical path) and other DRGs service platforms will greatly benefit from the DRGs nationwide promotion process. On the one hand, with the promotion of DRGs payment in the national health system, the number of hospitals with inpatient medical service qualifications nationwide exceeds, and the demand for client software development services based on DRGs grouping will become just needed; on the other hand, the clinical path management related It is required to be included in performance appraisal management. Compared with the original medical service management evaluation indicators, DRG performance appraisal is a comprehensive and more comparable dimension and a new medical service management evaluation index, which will replace the existing evaluation system of the hospital. effect.
Unified clinical pathways, will promote the integration of medical management of big data: Big Data applications medical pain point is that on the one hand the country to call for medical terminology is inconsistent, on the other hand medical services data (such as electronic medical records, imaging, radiation, gene System interfaces such as pharmacy data, pharmaceutical R&D data, and commercial insurance data are not open, and data loop closure cannot be formed, resulting in the inability to integrate medical big data. The unification of clinical pathways will unify the byte differences between medical institutions and Chinese and Western medicines on medical proper nouns, and solve a major pain point in medical big data fusion. With the continuous investment in medical informatization , the interface between medical institutions and pharmacies and medical insurance is unified, and medical big data will solve the pain points of information islands, and integration management becomes the trend of medical big data.
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