XX市新农合与商业保险公司信息系统对接研究

发布时间：2018-04-17 11:52

本文选题：新农合 + 商业保险　；参考：《山东大学》2014年硕士论文

【摘要】：新型农村合作医疗,简称新农合,是一项覆盖我国城乡农民医疗保障的重要制度。随着信息科学发展的日新月异,计算机技术也已广泛应用到了新农合领域中,信息化建设是新型农村合作医疗事业有效开展,实现科学管理的重要手段。党中央从试点运行时就非常重视新农合的信息化建设,从政策、规范制定以及资金投入等多方面加大投入力度。随着商业保险的加入,一方面新型农村合作医疗制度得到了补充和完善；另一方面新农合信息化建设也遇到了挑战,如何实现商业保险系统与新农合系统之间的无缝对接,业务流程的优化承接,同时又能保证双方的信息安全对新农合大病保险业务的长远发展至关重要。本文对比国内新农合信息系统发展概况,结合业务流程优化和基于视图的需求分析方法在信息系统中的应用,在商业保险参与新农合大病保险的政策背景下,以如何实现XX市商业保险公司与新农合之间的信息系统对接为研究对象。在研究的过程中,通过分析新农合系统与商业保险系统现状,并根据卫生系统和保险行业各自的行业特点,包括双方各自对信息系统功能、性能和安全性等多方面的综合需求,设计了解决方案。本文首先进行系统分析,对参合农民在定点医疗机构实现大病保险出院即报,在县区新农合网点实现域外就医后的非出院即报,以及商业保险公司内部如何接收数据,最终实现大病保险结算支付的整体流程进行了梳理和分析。在系统设计的过程中,本文列举了系统建设的总体设计原则,以此为基础对系统功能结构以及信息系统流程进行了分析与设计,并详细阐述了系统对接模式的设计思路；最后,从系统实施的角度出发,介绍了项目开展过程中有关项目管理方面的实施要点,并针对一些与信息系统建设有关的实际问题,例如在支付转账过程中,县区农民的银行卡普及率低等问题进行了分析并给出了建议。商业保险参与新农合医疗保障,是对新型农村合作医疗制度的一项重要补充,而科学、合理的设计信息系统对接,是促进政策有效开展的前提。希望本文的内容,能为今后新农合大病保险信息系统建设的发展起到微薄的参考作用,贡献一份力量。
[Abstract]:The New Rural Cooperative Medical system (NCMS) is an important system covering rural and urban farmers' medical security.With the rapid development of information science, computer technology has been widely used in the field of new agricultural cooperation. Information construction is an important means of effective development and scientific management of the new rural cooperative medical system.The Party Central Committee has attached great importance to the informatization construction of NCMS from the point of view of pilot operation, and has increased its input from many aspects, such as policy, standard formulation and capital input.With the entry of commercial insurance, on the one hand, the new rural cooperative medical system has been supplemented and improved; on the other hand, the information construction of the new rural cooperative medical system has also encountered challenges, how to realize the seamless docking between the commercial insurance system and the new rural cooperative medical system.At the same time, the information security of both sides is very important to the long-term development of NCMS insurance business.In this paper, the general situation of the development of NCMS information system in China, the application of business process optimization and view-based requirement analysis method in the information system, and the policy background of commercial insurance participating in NCMS insurance are discussed.How to realize the information system docking between XX commercial insurance company and NCMS is the research object.In the course of the research, by analyzing the current situation of the new agricultural cooperative system and the commercial insurance system, and according to the respective industry characteristics of the health system and the insurance industry, including the comprehensive needs of both sides for the function, performance and security of the information system,The solution is designed.This article first carries on the systematic analysis, reports that the participating farmers realize the serious illness insurance and discharge immediately in the designated medical institution, and how to receive the data inside the commercial insurance company after the new rural cooperative network in the county and district realizes the non-discharge report after the outside medical treatment, and how to receive the data inside the commercial insurance company.Finally, the overall process of realizing the settlement and payment of serious illness insurance has been combed and analyzed.In the process of system design, this paper enumerates the general design principles of system construction, analyzes and designs the system function structure and information system flow, and expounds the design idea of system docking mode in detail.From the point of view of system implementation, this paper introduces the key points of project management in the process of project development, and aims at some practical problems related to the construction of information system, such as in the process of payment and transfer.This paper analyzes the problems of low popularization rate of bank cards of farmers in county areas and gives some suggestions.The participation of commercial insurance in the new rural cooperative medical system is an important supplement to the new rural cooperative medical system, and the scientific and reasonable design of information system is the premise to promote the effective development of the policy.It is hoped that the content of this paper will play a reference role and contribute to the development of the new NCMS insurance information system in the future.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684;R197.3;F842.3

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