On March 11, the Fifth Session of the Thirteenth National People’s Congress officially closed. The annual government work reports of the two sessions are the focus of heated discussions, clarifying the development direction and goals for the coming year, which have great guiding significance for the national economy. The report mentioned that it is necessary to promote the development of the digital economy, cultivate and expand digital industries such as integrated circuits and artificial intelligence, and improve the innovation and supply capabilities of key software and hardware technologies. In the chapter on “improving the capacity of medical and health services”, a total of nine clear requirements are put forward.
The wave of digitalization is sweeping across all walks of life, and technological services such as big data and AI are also accelerating the penetration, and the medical industry is of course no exception. Insufficient medical supply and weak primary medical level are the two crux of the current sustainable development of medical care. Starting from the medical supply side, combining the Internet, artificial intelligence, 5G and other emerging technologies, and then realizing the “connection”, “efficiency” and “sinking” of medical resources, will become an important idea for the imbalance of supply of medical resources in links.
Therefore, combining the two major directions in the government work report, it can be clearly predicted that many emerging technologies such as medical AI and medical big data will play an increasingly far-reaching role in medical care, medical insurance, and medicine.
First,Deepen the reform of medical insurance payment methods and strengthen the supervision of medical insurance funds
Since its establishment in 2018, the National Medical Insurance Administration has made the supervision of medical insurance funds a top priority.
In July 2020, the General Office of the State Council issued the “Guiding Opinions on Promoting the Reform of the Supervision System of the Medical Security Fund”, which clearly requires “establishing and improving the medical insurance intelligent monitoring system and strengthening the application of big data. Accelerate the establishment of a centralized and unified intelligent monitoring system at the provincial and even the national level. The monitoring system realizes the transformation of fund supervision from manual selection and review to big data all-round, full-process, and all-link intelligent monitoring.”
From a functional point of view, medical insurance bureaus at different levels have different needs for medical insurance supervision. For example, national bureaus focus on standardization, intelligence and informatization, provincial bureaus focus on collaborative sharing, monitoring and evaluation, and municipal bureaus focus on daily handling and regulation.
Consistent with the overall medical reform trend and demand, AI and big data technologies are gradually moving medical insurance supervision into an intelligent era.
On the other hand, with the continuous expansion of medical insurance coverage, the huge number of insured people seeking medical treatment, the wide distribution of medical service institutions, the real-time medical insurance settlement, and the professionalism of medical diagnosis and treatment have put forward new requirements for medical insurance decision-making. .
The National Medical Insurance Administration clearly stated in 2019 that it requires the construction of a macro decision-making system covering the national, provincial and municipal levels, relying on big data actuarial technology to build a scientific decision-making analysis system, so that decision-makers can see the laws and essence behind the data, This will help policymakers identify mid- and long-term policy risks in a timely manner and measure the impact of policy regulation.
The refined management of medical insurance is an important part of “deepening medical reform”. At present, the construction of the main body of the national medical security information platform has been basically completed, and the national unified medical security information platform has been launched and used in many places across the country.
As early as 2019, informatization manufacturers such as Neusoft Group, Sichuan Jiuyuan Yinhai, Zhongke Soft Technology, Yilianzhong, Hunan Chuangzhi, Weining Technology, and Ping An Medical Insurance Technology participated in the competition of medical insurance informatization construction. In addition, BAT is also closely followed, Alipay, Tencent, etc. have also joined it.
Taking Ping An Medical Insurance Technology as an example, as of October 2021, Ping An Medical Insurance Technology has successfully won bids for 25 provincial-level platform system construction projects in the standardization construction of national medical insurance information, and has helped Shandong, Yunnan, Qinghai, Hainan, Guangdong, Guizhou, 20 provincial-level platform projects in Xinjiang, Tibet, Anhui, Heilongjiang, and Shaanxi were successfully launched (including trial operation).
Helping the government solve the problems of extensive medical insurance management, imbalanced revenue and expenditure, fraudulent insurance fraud, etc., and empowering the scientific decision-making and efficient operation of medical insurance management agencies, requires the support of more third-party medical informatization manufacturers.
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