医保基金智能审核和监控知识库、规则库是实现医保基金智能监管的核心技术支撑,医保部门依托“两库”,对各类监管对象进行全流程监控。本文梳理“两库”概念的内涵和外延、功能定位,介绍“两库”建设的典型经验,分析现阶段“两库”建设存在的数据采集和标准化困难、一体化管理困难等问题,提出实施分级管理机制等完善建议,以期为全面建立智能监控制度提供借鉴。
Abstract
Construction of the knowledge databases, rule database is the fundamental to the intelligent supervision of medical insurance funds. Relying on the “two databases”, the healthcare administration can monitors the whole procedure of all parties involved. The paper illustrates the connotation, extension, function of the "two databases", introduces the typical local experience, analyzes the difficulties in data collection, standardization, integrated management, other problems at the current stage, puts forward improvement suggestions such as implementing hierarchical management mechanism, providing reference for the comprehensive establishment of intelligent monitoring system
关键词
知识库 /
规则库 /
智能监控 /
基金监管
Key words
knowledge database /
rule database /
intelligent monitoring /
fund supervision
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