The field of hemodialysis is among priorities of the medical insurance department in providing service guarantee and fund supervision. In May 2022, four sectors including the National Healthcare Administration announced the Work Plan for the Unannounced Inspection of the Medical Security Fund in 2022, which for the first time explicitly checked the medical service behavior and medical expenses of designated medical institutions in areas such as hemodialysis that are included in the payment scope of the medical insurance fund. Based on big data analysis technologies such as clustering, time series and natural language processing, this research proposes to establish a medical insurance fund supervision path in the field of hemodialysis with policy configuration layer, algorithm technology layer (data warehouse), clinical diagnosis and treatment analysis layer, abnormal trend analysis layer and result output layer as the main process, and analyzes the application prospect of this path in medical insurance supervision.
Key words
hemodialysis /
supervision of medical insurance fund /
route
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