摘要
数智驱动的价值医疗作为当前国际医疗卫生领域的前沿理念之一,有望通过撬动系统性机制优化和全流程模式创新,促进医疗、医保、医药协同与高质量发展迈上新台阶。本文从当前“三医”协同高质量发展面临的问题与挑战入手,探讨了数智驱动的价值医疗与“三医”协同的关系及其得以发挥作用的路径和条件,并结合具体场景和典型案例对数字健康技术和价值医疗理念在促进“三医”协同高质量发展中的应用前景进行了展望,重点聚焦基于地理信息系统(GIS)整合多源异构数据的医疗卫生资源配置智慧工具、基于人工智能精算模拟的医保病种费用及支付标准确定、数智赋能的新药遴选与基于真实世界数据的上市后多维价值评价、以价值共识为导向的“三医”深度协同与数智融合创新发展。
Value-based healthcare driven by digital intelligence,as one of the cutting-edge concepts in the current international healthcare field,is expected to promote the coordination of medical services,medical insurance and pharmaceuticals and high-quality development to a new level by leveraging systematic mechanism optimization and whole-process model innovation.Starting from the problems and challenges faced by the current coordination of medical services,medical insurance and pharmaceuticals and high-quality development,this paper discussed the relationship between value-based healthcare driven by digital intelligence and the coordination of medical services,medical insurance and pharmaceuticals,as well as the paths and conditions for it to play a role.Combining specific scenarios and typical cases,it also looked forward to the application prospects of digital health technologies and the concept of value-based healthcare in promoting the coordination of medical services,medical insurance and pharmaceuticals and high-quality development,with a focus on the intelligent tools for the allocation of health resources that integrate multi-source heterogeneous data based on Geographic Information System(GIS),the determination of medical insurance disease costs and payment standards based on artificial intelligence actuarial simulation,the selection of new drugs empowered by digital intelligence and the post-marketing multi-dimensional value evaluation based on real-world data,and the deep coordination of medical services,medical insurance and pharmaceuticals oriented by value consensus and the innovative development of digital and intelligent integration.
出处
《中国医疗保险》
2025年第2期37-44,共8页
China Health Insurance
基金
国家社会科学基金重大项目“深化医改背景下的医疗、医保和医药协同发展和治理研究”(23ZDA103)。
关键词
“三医”协同
价值医疗
数智驱动
数字健康
coordination of medical services
medical insurance and pharmaceuticals
digital intelligence drive
digital health
