Medical Insurance Management System Research And Implementation

With the increasing development of computer networks information technology(IT), we have completely entered an information era. The rapid construction anddevelopment of Information technology in all areas changed the way people work,live and learn. With the rapid development of China’s medical and health services, thescale continues to expand and medical facilities have improved in recent years, thedegree of attention to medical and health undertakings are also increasing. Meanwhile,along with the advent of computer software as the core of the information age, therapid development of the modern information technology as well as the progress inscience and technology, the hospital’s information construction has become the maindevelopment direction for the future of hospital management. Establishing a fullyfunctional hospital information management systems have become not only animportant basis to measure the level of comprehensive strength of a hospital, but alsogradually become an important standard of patient to choose a hospital for medicaltreatment.With the development of hospital information construction, lots of problemshave been found gradually in the old system of the medical insurance reimbursementin the hospital medical insurance building because some departments still apply theactual cost payment health management system, and sometimes ineffective orinadequate government financial allocations will result in a deficit of public healthservice, which making department raise funds by themselves to cover the deficit. Inaddition, the old system of health insurance has significant limitations in aspect ofmanagement control. Some individual patient makes use of such system defects toforge medical receipts and documents to obtain reimbursement of medical insurance;furthermore, many patients are unable to enjoy convenience of medical insurance,which brought a lot of hidden dangers and drawbacks to medical insurance of oldsystem, So under all the disadvantages of the restrictions, China further improved themedical insurance system.As medical system reformed and medical insurance system improved, varioushospitals pay great attention to information construction to improve the quality of hospital services and increase the number of patients so that it will be moreconvenient for people who has to be hospitalized in the region with a Medicare.Different cities, regions and each hospital establishing a new-type Medicare insurancemanagement system with the features of the region has become an importantdevelopment trend for the basic medical insurance in the hospital. This managementsystem is not only convenient for the majority of patients to be hospitalized, but alsohelpful on work efficiency of the Medical Insurance Bureau. Meanwhile, the entiremedical insurance reimbursement is implemented in an electronic and informationway to avoid the original security risks, which make our country’s construction ofMedicare insurance better.This paper systematically based on C/S mode of medical insurance managementsystem realization and implementation makes a detailed elaboration, point to that themedical insurance in the hospital has the characteristics of management fee, based onthe existing hospital information management system mode, choose the suitabledevelopment platform,and that the Harbin medical insurance management systemdevelopment framework should be paid attention to choose the factors. Relativelycomplete presented the medical insurance management system technology frameworkand business framework. Realize the real-time management of the medical insuranceoutpatient fee and charge of be in hospital, strictly control the medical insurancepatients when go to a doctor of medical expenses generated review and submit anexpense account process, and the standard is the medical insurance scope anddiagnosis and treatment of drug management system project.In the designing process, this system revolves mainly around the two corefunctions, patient charges management and hospital charges management. The focusof study is to solve the problem and realize the integration of Medicare insurancemanagement versatility and back-stage management system processes of Medicareinsurance center. Concerning Outpatient charges management，it is implemented tomake Medicare patients see a doctor with a Medicare card function to solve theoutpatient expenses designated Medicare card reimbursement. And with regard toinpatient charges management, the function is mainly about auditing, billing andreimbursement of hospitalization fee for Medicare patients with a Medicarecard. These operations are combined with back-stage medical center cost managementprogram, and real-time details of the Medicare patients cost and hospitalizationreimbursement, audit situation will be sent to Medicare data center for unifiedmanagement. Medical insurance reimbursement function of out-patients is achieved in scale bymaintenance for drug prices and dictionary, health care clinic project, diseases inputmethod within the scope of health insurance as per the medical insurance system andthe policies and regulations; medical insurance reimbursement function ofhospitalized-patients achieved by maintenance for drug prices and dictionary, healthcare clinic project, diseases input method as well as departments, wards, beds projectdata. Through this system, hospital could not only improve Medicare insurancereimbursement system and regulate Medicate insurance drugs according to actualpatients condition, combining with Medicare insurance reimbursement regulations toimprove reimbursement process of Medicare insurance patients, but also raiseback-end data consistency and timeliness for the hospital and medical center, whichwill provide more accurate data for the reimbursement of Medicare patients andimprove the work efficiency of the medical center, and ultimately provide the betterservices for Medicare patients.This system comprehensively and systematically expounded the PowerBuilderdevelopment platform, the Oracle9i database and C/S-mode technology, mainlyincluding the introduction of PowerBuilder; description of C/S mode applicationframework system; introduction of Oracle database technology which could providenecessary theoretical basis for building the management system of Medicareinsurance.And this paper also describes the content for the original and existingsystem of our country’s Medicare insurance system, which provides the necessarypolicy basis for management system of medical insurance.