历时5年,医保信息化经历了顶层设计、全面建设、逐一上线、逐一验收、全面应用等里程碑。在国家医保局的指导下,各地医保部门也进一步转变工作思路,从“有平台”“用平台”到“好平台”“用好平台”,从“有数据”“用数据”到“好数据”“用好数据”。数据是新质生产力的核心组成部分,医保大数据也已成为医保服务改进与优化的关键驱动力。本文通过回顾医保大数据应用发展历程、研究医保大数据应用现状和面临的问题,探索医保大数据在促进医保服务提质增效方面的应用场景,为医保大数据赋能医保服务提供借鉴和思路。

Over five years, the medical insurance informatization has gone through milestones such as top-level design, full construction, deployment, acceptance check, and comprehensive application. Under the guidance of the National Healthcare Security Administration, healthcare security administration in various regions have further transformed ideas, from "having platforms" and "using platforms" to "good platforms" and "using platforms well", as well as from "having data" and "using data" to "good data" and "using data well". Data is the core component of new quality productive forces, and medical insurance big data has become a key driving force for improving and optimizing medical insurance services. This article explores the application scenarios of medical insurance big data in promoting the quality and efficiency improvement of medical insurance services by reviewing the development history of medical insurance data applications, and studying the current situation and problems of medical insurance big data applications, in order to provide references and ideas for empowering medical insurance services with medical insurance big data.