随着医疗服务价格改革全面进入“项目标准化”阶段,公立医院在价格合规执行方面面临日益严格的刚性要求。当前价格维护机制更新滞后、临床规则执行复杂且易出错、事中计费高度依赖人工操作、事后监管闭环机制不健全等现实问题,导致合规成本攀升与违规风险加剧的双重压力。针对上述困境,本文提出智能价格管理系统的设计构想,以临床流程嵌入、风险闭环治理、政策精准适配及管理主动赋能为核心理念,设计事中判定与预出院判定两级管控机制,整合核心功能模块与多源数据支撑体系,并提出自然语言处理技术用于政策规则结构化转化的思路。该构想为公立医院医疗服务价格管理从被动应对向主动优化转型提供了一套技术思路与实施框架参考。

As the reform of medical service price enters the phase of "item standardization", public hospitals face increasingly stringent compliance requirements in price governance. Currently, delayed price maintenance updates, complex and error-prone clinical rule enforcement, heavy reliance on manual billing processes, and inadequate closed-loop mechanisms for post-hoc regulation, leading to the dual pressures of rising compliance costs and heightened violation risks. To address these challenges, this paper proposes a design concept for an intelligent price management system grounded in principles of clinical workflow integration, closed-loop risk governance, precise policy adaptation, and proactive management empowerment. The design features a two-tier control mechanism comprising in-process review and pre-discharge review, integrates core functional modules with a multi-source data infrastructure, and employs natural language processing techniques for the structured transformation of policy rules. This concept offers a technical framework for transitioning public hospital price management from passive response to proactive optimization.