济南市城乡居民医疗保险管理信息系统的设计与实现
发布时间：2019-02-26 14:19
【摘要】：当前,我国基本医疗保障体系由新型农村合作医疗保险、城镇居民医疗保险、城镇职工医疗保险共同构成。由于顶层设计先天不足,近年来城乡居民医保制度分设造成的管理分散、基金使用效率低、抗风险能力弱等问题日益突显,这不仅固化了城乡二元社会结构,更无法体现社会保障的公平性,引起全社会的广泛关注。为进一步整合城乡基本医疗保险管理职能,2013年11月,山东省人民政府出台相关政策,整合全省城镇居民基本医疗保险和新型农村合作医疗,建立全省统一、城乡一体的居民基本医疗保险制度,新农合职能、编制、人员的管理等整体由原卫生部门移交到人力资源社会保障部门。按照省政府的要求,济南市于2014年6月完成了两项制度的整合,建立起新的城乡居民医疗保险制度,为实现全市城乡居民医保信息化,需在现有城镇居民医保系统基础上,建设市级集中的城乡居民医疗保险管理信息系统。本文设计和实现的济南市城乡居民医疗保险管理信息系统旨在整合全市城镇居民医疗和新农合业务,使全市各区县城乡居民医疗保险在政策、业务经办、管理决策上实现统一,并确保参保经办等各项数据的原始性、真实性、完整性和集成性。通过建设新的医疗保险管理信息系统,实现了参保信息管理(参保人员个人信息、经办机构信息、参保集体信息等)、基金征缴管理(费用单据、银行代扣)、特殊业务管理、医疗待遇支付、定点医疗机构管理、定点医疗机构结算、三大目录管理、待遇资格认证、查询统计等业务功能。济南市城乡居民医疗保险管理信息系统采用人社部规定的核心平台三版技术架构和数据指标规范开发,属于本地化的开发。本文首先分析了济南市城乡居民医疗保险管理信息系统的背景和意义,以及国内外相关系统的研究现状；其次分析了济南市城乡居民医疗保险管理系统的需求,按照面向对象的软件工程开发模式,采用统一建模语言UML对本文系统进行了需求建模分析；然后,基于MVC模式和J2EE平台体系结构等成熟的关键技术,采用B/S/S三层架构,并结合面向服务的架构SOA,对系统进行了整体架构和技术架构两方面的设计,保证了系统的可伸缩性和可扩展性；在此基础上,分析了系统的安全架构设计,确定了系统的详细设计,包括系统功能模块设计以及数据库设计等；最后,针对济南本地城乡居民医疗保险行业的业务特点,对本文提出的医疗保险管理信息系统进行了本地化的扩展及实现,并对系统进行了详细的测试。
[Abstract]:At present, the basic medical insurance system of our country is composed of the new rural cooperative medical insurance, the urban resident medical insurance and the urban worker medical insurance. Due to the inborn shortage of the top-level design, the decentralized management caused by the separate establishment of the medical insurance system for urban and rural residents in recent years, the low efficiency of fund use and the weak ability to resist risks have become increasingly prominent, which not only solidifies the dual social structure of urban and rural areas. Moreover, the fairness of social security can not be reflected, which has aroused wide concern of the whole society. In order to further integrate the management functions of urban and rural basic medical insurance, in November 2013, the people's Government of Shandong Province issued relevant policies to integrate the basic medical insurance for urban residents of the province and the new type of rural cooperative medical care to establish the unity of the province. The integration of urban and rural residents basic medical insurance system, new agricultural cooperation functions, establishment, personnel management from the original health department to the human resources social security department. In accordance with the request of the provincial government, Jinan completed the integration of the two systems in June 2014, and established a new medical insurance system for urban and rural residents. In order to realize the informatization of urban and rural residents' medical insurance, it is necessary to build on the existing urban and rural residents' medical insurance system. Construction of city-level centralized medical insurance management information system for urban and rural residents. The medical insurance management information system for urban and rural residents in Jinan designed and realized in this paper aims at integrating the medical treatment of urban residents and the new agricultural cooperation business of the whole city, so that the medical insurance of urban and rural residents in all districts and counties of the city can be unified in policy, business management and management decision-making. And ensure the original, authenticity, integrity and integration of all kinds of data. Through the construction of a new medical insurance management information system, we have realized the management of insurance information (personal information of insured personnel, agency information, collective information of insurance), fund collection and management (expense documents, bank withholding), special business management, etc. Medical treatment payment, fixed-point medical institutions management, fixed-point medical institutions settlement, three categories of management, treatment qualification certification, query statistics and other business functions. Jinan city urban and rural residents medical insurance management information system adopts the core platform of the Ministry of Human and Social Affairs three edition technical framework and data index specification development, belongs to the development of localization. Firstly, this paper analyzes the background and significance of medical insurance management information system for urban and rural residents in Jinan, as well as the research status of related systems at home and abroad. Secondly, the demand of Jinan City Medical Insurance Management system is analyzed. According to the object-oriented software engineering development mode, the unified modeling language (UML) is used to model the requirements of the system. Then, based on mature key technologies such as MVC pattern and J2EE platform architecture, B/S/S three-tier architecture and service-oriented architecture SOA, are used to design the overall architecture and technical architecture of the system. Ensure the scalability and scalability of the system; On this basis, the security architecture design of the system is analyzed, and the detailed design of the system is determined, including the design of the system function module and the design of the database. Finally, according to the business characteristics of the local urban and rural residents medical insurance industry in Jinan, the localization of the medical insurance management information system proposed in this paper is extended and implemented, and the system is tested in detail.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：TP311.52
本文编号：2430854
[Abstract]:At present, the basic medical insurance system of our country is composed of the new rural cooperative medical insurance, the urban resident medical insurance and the urban worker medical insurance. Due to the inborn shortage of the top-level design, the decentralized management caused by the separate establishment of the medical insurance system for urban and rural residents in recent years, the low efficiency of fund use and the weak ability to resist risks have become increasingly prominent, which not only solidifies the dual social structure of urban and rural areas. Moreover, the fairness of social security can not be reflected, which has aroused wide concern of the whole society. In order to further integrate the management functions of urban and rural basic medical insurance, in November 2013, the people's Government of Shandong Province issued relevant policies to integrate the basic medical insurance for urban residents of the province and the new type of rural cooperative medical care to establish the unity of the province. The integration of urban and rural residents basic medical insurance system, new agricultural cooperation functions, establishment, personnel management from the original health department to the human resources social security department. In accordance with the request of the provincial government, Jinan completed the integration of the two systems in June 2014, and established a new medical insurance system for urban and rural residents. In order to realize the informatization of urban and rural residents' medical insurance, it is necessary to build on the existing urban and rural residents' medical insurance system. Construction of city-level centralized medical insurance management information system for urban and rural residents. The medical insurance management information system for urban and rural residents in Jinan designed and realized in this paper aims at integrating the medical treatment of urban residents and the new agricultural cooperation business of the whole city, so that the medical insurance of urban and rural residents in all districts and counties of the city can be unified in policy, business management and management decision-making. And ensure the original, authenticity, integrity and integration of all kinds of data. Through the construction of a new medical insurance management information system, we have realized the management of insurance information (personal information of insured personnel, agency information, collective information of insurance), fund collection and management (expense documents, bank withholding), special business management, etc. Medical treatment payment, fixed-point medical institutions management, fixed-point medical institutions settlement, three categories of management, treatment qualification certification, query statistics and other business functions. Jinan city urban and rural residents medical insurance management information system adopts the core platform of the Ministry of Human and Social Affairs three edition technical framework and data index specification development, belongs to the development of localization. Firstly, this paper analyzes the background and significance of medical insurance management information system for urban and rural residents in Jinan, as well as the research status of related systems at home and abroad. Secondly, the demand of Jinan City Medical Insurance Management system is analyzed. According to the object-oriented software engineering development mode, the unified modeling language (UML) is used to model the requirements of the system. Then, based on mature key technologies such as MVC pattern and J2EE platform architecture, B/S/S three-tier architecture and service-oriented architecture SOA, are used to design the overall architecture and technical architecture of the system. Ensure the scalability and scalability of the system; On this basis, the security architecture design of the system is analyzed, and the detailed design of the system is determined, including the design of the system function module and the design of the database. Finally, according to the business characteristics of the local urban and rural residents medical insurance industry in Jinan, the localization of the medical insurance management information system proposed in this paper is extended and implemented, and the system is tested in detail.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：TP311.52
【参考文献】
相关期刊论文 前1条
1 ;鲁城乡居民医保今年并轨[J];中国信息界(e医疗);2014年01期
，本文编号：2430854
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