● the total investment of the project is 20.5 million yuan, realizing the collection, management and application of medical insurance data in 21 cities in the province;
● the construction contents include early warning index management, fund operation monitoring, insurance participation monitoring, medical behavior monitoring, drug consumables monitoring, designated institutions monitoring, etc;
● realize the analysis, early warning and intelligent decision-making of the operation of medical funds in cities across the province;
● carry out thematic analysis on single disease and average cost per time according to the needs of medical insurance monitoring business.
With the establishment of the medical security bureau, the duties of drug and medical service price management, new rural cooperative medical care, basic medical insurance for urban workers and urban residents, maternity insurance, medical assistance and other duties scattered in the development and reform, health, human resources and social security, civil affairs and other departments have been terminated at one fell swoop, and the medical insurance reform has entered a new era.
Medical insurance business is always accompanied by the flow of funds: insurance premiums need to be paid when participating in insurance, bookkeeping fees are involved in medical treatment and drug purchase settlement, and monthly settlement involves the payment of fees to medical institutions. Starting from the unified management of funds, we will be able to grasp the "throat" of the medical insurance business: on the one hand, we can comprehensively and timely grasp the capital status of each overall planning area under our jurisdiction; on the other hand, we can track and supervise the business data according to the capital flow. To this end, Heyu health R & D launched the "medical security fund overall management system".
Real time monitoring of external transactions of all fund accounts in each overall planning area under its jurisdiction is achieved by connecting with relevant banks through real-time interfaces, and dynamic control of the fund status of each insurance type under its jurisdiction and each overall planning area is carried out; And according to each flow of funds, it can match and check with the medical insurance business to realize the fund business integration processing: the medical security fund overall management system also supports the automatic generation of relevant financial vouchers according to the fund business records and the matching results of the business, realizes the business finance integration, and automatically generates the balance sheet, income and expenditure statement and other fund financial statements of various types of insurance and the overall planning area, so as to realize the unified financial management of the whole jurisdiction; It also supports the business processing needs related to the automatic generation of budget preparation and final accounts.
The characteristics of the medical security fund overall management system, such as "direct connection of insurance and banking", "integration of fund business finance", "unified financial management throughout the jurisdiction" and "integration of budget and final accounts", will provide strong information support for the overall management of provincial funds.
The medical security operation dynamic supervision system realizes real-time: dynamic monitoring support for the medical insurance business dimension from the four dimensions of "Insured", "fund operation", "medical service" and "medical equipment supply".