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    全國醫保系統將實現“一碼通”
    日期:2019-06-29 10:47:18  來源:友情轉載    字號: T | T

      中新網客戶端6月28日電(記者 張尼)記者從國家醫保局了解到,目前,國家醫保局已完成醫用耗材、醫療服務項目等4項醫保信息業務的全國統一編碼。
     
      這項工作的完成,意味著全國醫保系統將實現“一碼通”,患者今后異地就醫不僅更加方便快捷,同時也將有效堵住醫保系統上的“跑冒滴漏”。
     
      4項業務在醫保系統實現“一碼通”
     
      27日,國家醫保局在北京召開醫保信息化和標準化建設座談會。
     
      記者從會上了解到,從醫保信息化建設情況看,長期以來全國存在標準代碼不一致、信息系統碎片化嚴重、醫保公共服務水平參差不齊、醫保大數據應用不充分等問題。
     
      為建立全國統一的醫保信息業務編碼體系,推動形成全國自上而下醫保信息數據交換的“通用語言”,國家醫保局去年8月啟動了醫保疾病診斷和手術操作、藥品等15項主要業務信息編碼的研究制定工作。
     
      目前,國家醫保局已完成醫保疾病診斷與手術操作、藥品、醫用耗材、醫療服務項目等4項核心編碼標準的規則制定、數據庫建設和動態維護窗口搭建工作。
     
      這意味著,這4項業務將在全國醫保系統實現“一碼通”。
     
      6月27日,在國家醫療保障局的官方網站“醫保業務編碼標準動態維護”窗口上線試運行。
     
      為異地就醫結算提供支持
     
      實現醫保系統“一碼通”將為患者帶來哪些實惠?
     
      通俗來講,過去,各地醫保藥品、醫用耗材、醫療服務項目等編碼不一致,就如同各自在說“方言”,沒有形成“普通話”,造成各地醫保工作中普遍存在標準不統一、數據不互認等問題。
     
      這一問題影響了異地就醫結算等工作的進一步完善,同時,醫保本部門也無法開展有效的大數據分析應用。
     
      例如,同樣的醫用耗材在A省與B省編碼不一致,就會出現患者在A省可報銷,但到B省異地就醫后無法報銷,導致患者不得不自掏腰包。但形成全國統一編碼后,這一問題就可得到破解,給患者帶來實惠。
     
      此外,以醫用耗材為例,現行耗材注冊批件中規格型號種類繁多、數量龐大,甚至同一個批件下有幾萬個品規,難以進行有效管理。
     
      全國醫用耗材招標、采購和醫保支付均沒有形成統一的編碼標準,相關部門出臺過一些編碼目錄,但都沒有在全國范圍使用,導致各地醫用耗材管理工作量大,重復性工作多。
     
      此次國家醫保局制定全國統一的醫保醫用耗材分類與代碼,能夠推進醫用耗材“招標、采購、醫保支付”全過程信息的互聯互通,有利于醫保大數據分析和精準管理。
     
      堵住醫保基金“跑冒滴漏”
     
      除了方便患者進行異地就醫外,醫保系統實現“一碼通”還將有效堵住醫保基金的“跑冒滴漏”。
     
      該窗口將全國各地數據納入統一編碼,梳理重復數據進行剔除。例如:將收集的100多萬疾病診斷數據融合形成3萬多編碼、收集的各地自編碼200多萬條藥品數據統一賦碼成25萬多、收集各地28萬多的醫療服務項目統一編碼為1萬多,約千萬條的醫療耗材分類編碼為約百萬條。
     
      “過去有些醫療機構為了亂收費,設置了名目繁多的醫療服務項目,但統一編碼后將嚴格按照國家統一標準分類,遏制上述現象。”國家醫保局相關負責人向記者介紹。
     
      另外,除了已經制定統一編碼的4項業務外,定點醫療機構代碼、定點零售藥店代碼、醫保醫師代碼、醫保結算清單等其他11項編碼標準規則已基本確定,正在征求各地的意見建議。
     
      今后,15項主要業務編碼標準將應用到統一信息平臺,促進跨部門、跨地區、跨層級的信息交換與安全共享,真正打通“三醫聯動”通道。
     
      同時,統一信息化平臺建設將有助于醫保部門掌握全國大數據,為推進藥品集中采購、醫保目錄調整以及規范醫療機構收費等工作提供有力支撐。
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