医保监管是医保管理的重点任务,在数据时代,医保大数据的充分应用是推动医保监管能力现代化的有力支撑,也是医保经办管理不可或缺的技术手段。上海市作为国家智能监控示范点,积极探索建立医保安全管理信息平台,应用大数据挖掘新技术建立数据模型,推动数据质量提升及精细化管理水平,有效监管医保基金。本文探讨上海市医保智能监管的建设与发展历程,通过案例分析介绍数据挖掘技术在医保基金监管中的应用,并分享成果与效益以期提供经验与启示。

Medical insurance supervision is a priority in the management of medical insurance. In the era of big data, the full application of medical insurance data is the strong support of medical insurance supervision modernization and an indispensable technical means for medical insurance agency management. As a national intelligent monitoring demonstration city, Shanghai actively explores the establishment of a medical insurance security management information platform, applies new technologies for big data mining to establish data models, promotes the improvement of data quality and refined management, and effectively supervises medical insurance funds. This article explores the construction and development of intelligent medical insurance supervision in Shanghai, introduce the application of data mining technology in supervision with case analysis, and share achievements and benefits for other cities.