| At current,our country's basic medical insurance fund expenditure is increasing year by year and the growth is significant.Although the cause can be attributed to the increasing coverage rate of population year by year,the possibility that the fund is abused or illegally arbitraged should be typically avoided or eliminated.Traditional control means of medical insurance cost are mainly artificial audit during healthcare settlement and the management mode of total prepaid system.But artificial audit pattern has problems in the process of development,such as low efficiency,poor coverage,error-prone,unsuitable for replication of successful experience,and incapable of sustainable development with the rapid growth in data etc.Meanwhile,the total prepaid system is likely to damage the enthusiasm of medical institutions instead of fundamentally solve the problem of misuse of medical insurance fund.The popular automatic health care audit system in recent years can increase the audit coverage and reduce artificial operation to a certain extent,however,with observations and analysis,we found this system is based on post verification and there exist following questions:1.Difficult to realize "beforehand warning" and "during the event monitoring";2.Information isolated island caused by big difference of audit standard,which makes the health care institutions difficult to conduct joint inspection;3.Dispute between administrative agencies and hospitals caused by non-transparence of audit policy;4.Waste of social resources caused by repeated constructions of hospital automatic audit systems.Through the study of current medical insurance operating mode,we think the root cause of difficulties in present medical care audit are over centralized management mode and Medicare agencies each fights his own battle.Therefore with the thorough research of current popular technology of Block Chain and smart contract,we realized that the Block Chain technology's decentralized governance mechanism and information publication feature,as well as intelligence contract technology's programmed automatic performance mechanism will become an important method to resolve Medicare audit dilemma.Based on above work,we put forward the new Medicare operation system and discussed its working mechanism in theory.This is a decentralized health care operation mode with participants including the insured,designated hospitals and pharmacies,health agencies and medical insurance professional,all participants in the system can work together with free combination to complete the operation of insurance business.The new system has the characteristics of eight aspects:information connectivity,reduce of traditional red tape,automation of decentralized audit and settlement,due consideration to standardization and individuality of audit policy,flexible and controllable audit scale recognized by both sides,decentralized and flexible netted task structure,comprehensive data,and enable health insurance management to be more focused on safeguard purpose.We hold the opinion that,in theory,it's feasible to solve our country's Medicare audit dilemma even certain problems in current health care system with the technology of Block Chain.We built the network architecture of new health system based on Block Chain technology,expounded its operation principles and implementation strategies,meanwhile,we defined the IT system object model of each participants in the network.We named this new heath care system "health care chain",and recommend building a complete technical scheme,development standards as well as the founding node of the network,by authority and technical strength of the state.Simultaneously,we aware that conditions are not mature enough for immediate implementation,which are mainly embodied in the lack of technical talent reserves,cognitive level to be enhanced,and defects in Chain Block technology itself.However,we consider the proposed solution in this paper to be very effective once the above three aspects meet the requirements. |
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