The Progress of Digital Intelligence in Medical Insurance Governance and the Challenge of Digital Formalism

doi:10.19546/j.issn.1674-3830.2024.7.006

China Health Insurance ›› 2024, Vol. 0 ›› Issue (7) : 51-61. DOI: 10.19546/j.issn.1674-3830.2024.7.006

Observation & Discussion

The Progress of Digital Intelligence in Medical Insurance Governance and the Challenge of Digital Formalism

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Abstract

At present, the platform-led digital transformation of the medical insurance claim management and fund administration system has achieved significant milestones. However, the challenge of digital formalism has emerged as a notable issue in the process of digital governance within the medical insurance system. This paper examines specific practice during the construction and development of the national medical insurance information platform, recognizing the achievements while addressing the problems. It categorizes the phenomenon of digital formalism into three types: upward accountability due to the ecological constraints of top-level design, algorithmic accountability stemming from the malfunctioning use of digital technology, and organizational accountability resulting from the paradigm shift driven by the platform. By critically examining the evolution of digital formalism in healthcare security governance from an academic perspective, we can deconstruct the generative logic underlying contemporary platform-driven digital formalism. Through the lenses of algorithmic imagination, digital labor, and game of data factor, it becomes evident that the "platform-driven government" tends to extensively connect multiple stakeholders, yet faces numerous challenges in achieving collaborative governance. Transitioning from being a media tool for integrated planning, to a technical means for enhancing overall administrative efficiency, to a governance mechanism for public organizations, the platform serves not only as a digital infrastructure for building the medical insurance governance system but also as a reconfigurator of the associated social and production relations. Exploring the optimization of the platform in medical insurance management and administration services will aid in advancing the modernization of the governance capabilities of the medical insurance information platform.

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medical insurance platform / digital formalism / digital governance

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The Progress of Digital Intelligence in Medical Insurance Governance and the Challenge of Digital Formalism[J]. China Health Insurance. 2024, 0(7): 51-61 https://doi.org/10.19546/j.issn.1674-3830.2024.7.006

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