Design And Implementation Of Medical Insurance Monitoring System

With the continuous expansion of social insurance coverage and the improvement of social security level,there are still many problems in the supervision of medical insurance on medical service behavior.Some designated medical institutions and service personnel are driven by interests to operate irregularly and set up medical insurance funds.However,there are also inadequate professional standards,lack of supervisors and real-time auditing in manual supervision.Insufficient sex and other issues.With the help of advanced information technology,medical insurance regulators can supervise medical service behavior,improve monitoring management mechanism and social insurance anti-fraud system,and ensure the security of national social security funds.Based on this,a medical insurance monitoring system has been developed.The main achievements can be summarized as follows:(1)Medical supervision and its influencing factors are comprehensively analyzed,and the key index system of supervision is given.This thesis analyses the business management behavior of insured personnel,medical personnel and medical insurance institutions in medical service behavior,establishes corresponding medical service mode according to business management,and then formulates current relevant monitoring index system for specific mode.(2)Design and implement the medical insurance supervision system.The system is audited in this paper.The system architecture is based on B/S/S multi-layer model of JaveEE platform.The UI layer is based on RIA application of Web 2.0.The UI interface is based on ExtJS framework,and the chart is based on FusionChart control.At the same time,according to the settlement information generated by the social insurance business management system for exchange,monitoring and screening processing,information audit processing,and then the reverse link with the settlement system,the way of data synchronization is incremental synchronization every day.All interface data transmission of the system adopts the lightweight and independent cross-platform communication technology Web service for data transmission.(3)Combining with data analysis technology,the mining and early warning of doubtful points and doubtful objects are realized.The business management behavior of insured personnel,medical personnel and medical insurance institutions in medical service behavior is analyzed,and the corresponding medical service mode is established according to the business management.Then the monitoring indicators are formulated for the specific mode,and the monitoring indicators are set.In addition,through the analysis of exchange data of medical service system,monitoring indicators and shortcomings are analyzed,and doubts and doubtful objects are found,so as to realize the monitoring of key medical service behaviors(4)A practical system has been realized.The application of this system has achieved obvious economic and social benefits.From the economic point of view,the medical insurance monitoring system is widely used in some areas with high insurance participation rate According to the statistical results,the effect is more remarkable.The average annual medical expenditure decreases by 10%,the balance rate of overall fund is basically controlled at about 13%,the burden rate of individual medical care is also significantly reduced,and the expenditure of medical fund is in a controllable range.At the same time,from the aspect of social benefits,the use of the medical insurance monitoring system standardizes the behavior of medical insurance service,promotes the fairness of medical treatment,reduces the occurrence of medical disputes,better safeguards the interests of insured personnel,and realizes the sustainable development of medical insurance fundamentally.