摘要
随着我国医疗保障体系不断完善,医保基金规模得以稳步扩大。然而这也在一定程度上加大了医保基金监管难度。在此背景下,运用大数据分析技术对医保全流程开展智能化监管,已成为提升医保管理效能、深入推进医保改革的关键路径。文章立足医保全流程智能监管中所应用的大数据分析技术,从事前、事中、事后三个环节切入,梳理并提出医保全流程智能监管中大数据分析技术运用要点,同时针对数据壁垒、隐私保护、模型迭代等维度存在的技术瓶颈,提出了相应的对策,以期为完善医保智能监管体系、保障医保基金安全高效运行提供参考。
With the continuous improvement of China’s medical security system,the scale of the medical insurance fund has been steadily expanding.However,this has also increased the difficulty of regulating the medical insurance fund to a certain extent.In this context,employing big data analysis for intelligent regulation of the whole medical insurance process has become a key path to enhance the efficiency of medical insurance management and further advance medical insurance reform.Hence,based on the big data analysis technology applied in the intelligent regulation of the whole medical insurance process and focusing on the three phases of pre event,in-event and post-event,the article summarizes and proposes the key points of applying big data analysis in the intelligent regulation of the whole medical insurance process.At the same time,corresponding countermeasures are put forward to address the technical bottlenecks in dimensions such as data barriers,privacy protection and model iteration,in order to provide references for perfecting the intelligent regulation system of medical insurance and ensuring the safe and efficient operation of medical insurance funds.
作者
李艳梅
Li Yanmei(Beijing Jingmei Group General Hospital Medical Insurance Office,Beijing 102300)
出处
《中阿科技论坛(中英文)》
2025年第10期27-31,共5页
China-Arab States Science and Technology Forum
关键词
医保
智能监管
大数据分析技术
医保基金安全
数据治理
Medical insurance
Intelligent regulation
Big data analysis
Security of medical insurance fund
Data governance
