"The insured person is the E-level insured person, the remaining 60-day dose of the drug vitamin D3 calcium carbonate, and the remaining 60-day dose of the drug aluminum magnesium carbonate; the patient has had 5 outpatient visits today; the patient has a medical treatment today The number has reached 5; the number of patients visiting this month has reached 8." - This is the pre-existing reminder function of the Xiamen Smart Medical Insurance Information Management Platform (hereinafter referred to as "Smart Health Insurance") before the doctor prescribes the prescription. One day at the end of March 2016, Dr. Guan Tianjun showed the practical application of smart medical insurance to the reporter of China Insurance News at the Department of Nephrology Clinic of Zhongshan Hospital affiliated to Xiamen University. Guan Tianjun said that before the application of smart medical insurance, doctors can't grasp the same kind of drugs that the same insured person can open the same kind of drugs in different medical institutions. After the medical insurance is on the line, you can clearly know the remaining dose of the insured and the number of outpatient visits, and effectively prevent it. Medicine mouse." Wisdom medical insurance also has a reminder function in the event (after the doctor prescribes the prescription, before the settlement), and the pre-existing reminder function constitutes a platform to pay attention to the "real-time reminder" system for preventing the problem, that is, the behavior of the diagnosis and treatment of suspected violations, to the medical staff, the designated institution and the reference The real-time warning of the guarantor has enabled many doctors to avoid passive or active violations caused by human circumstances. Wisdom medical insurance was officially launched in April 2014. It has been fully deployed in Xiamen's designated medical institutions. A total of 522 medical institutions have been opened, connecting 7346 doctor workstations, and seamlessly connecting with 99.06% of doctor workstations in Xiamen. It is understood that smart medical insurance services in management, according to management services, mainly have five application systems, real-time reminder system based on prevention (pre-existing and reminding), data mining-based hierarchical analysis system, risk control The main comprehensive evaluation system, the intelligent audit system for post-mortem review and the integrity management system for integrity records. Among them, the real-time reminding system, the intelligent auditing system, and the integrity management system have been officially launched, and the initial utility has been exerted in the supervision work; the layered analysis system and the comprehensive evaluation system have been put into the line and are still in the process of improvement. Significant control effect Lin Quanshui, deputy director of the Human Resources and Social Security Bureau of Xiamen, said that smart medical insurance is the professional service capability and talent advantage of Xiamen commercial insurance company, combined with Xiamen's many years of medical monitoring practice experience and advanced concepts, by Ping An Pension Insurance Co., Ltd. Headquarters mobilized system-wide resources for independent research and development, the main purpose is to solve the two problems of “medical insurance fund risk control†and “expensive medical treatment†that have plagued the medical insurance department for many years, and realized the screening and monitoring of waste, abuse and fraudulent medical insurance fund behavior. The tentacles of supervision extend to specific medical service behaviors, which promotes the transformation and upgrading of medical insurance supervision methods from ex post investigation to ex ante prevention and in-process control. It is an effective practice of PPP mode. The data shows that since its inception, as of December 31, 2015, the smart medical insurance rules triggered 1.06 million times, of which 1.04 million were reminded beforehand, the effective reminding rate reached 89.51%, and the effective prevention of 93 million people has 30 days remaining. There are still violations of the intention to overtake drugs; 16740 audits were conducted in the event, effectively blocking 7043 problem documents, and a large number of violations were imposed before the expenses occurred. The increase in medical expenses for credit card in Xiamen City decreased by 0.58% year-on-year, and the cost expenditure was reduced by 31.239 million yuan. Among them, the increase in medical expenses for card medical insurance decreased by 1.00% year-on-year, and the cost expenditure was reduced by 4,702,380 yuan. The phenomenon of drug-opening tends to decrease, and the outpatient service in the city focuses on drugs. The cost reduction expenditure was 26.45 million yuan. Compared with the July and December 2015 data, the total number of violations and the costs involved are gradually reduced, including the use of special diseases, children's use of drugs, non-indications, ultra-short-term hospitalization, surgical grade management, etc. 6,680,500 yuan, the number of suspected illegal documents decreased by 83,029. According to the investigation of the medical and health department of the People's Liberation Army 174 Hospital and the outpatient doctor of the Zhongshan Hospital affiliated to Xiamen University, the overall operation of the system was stable and the doctors approved the medical insurance audit results. Not only that, Li Yongzhong, deputy dean of Zhongshan Hospital affiliated to Xiamen University, told reporters that the platform is very popular with doctors and that after its application, it has great benefits. Before the doctors needed to check the prescriptions, they knew that the medications were systematically monitored. When I found out that there was a problem, I would like to respond, and I suddenly blocked the "doctors opening drugs." Gao Jing, general manager of Ping An Pension, said that commercial insurance companies, whether they are handling major illness insurance or operating supplementary medical insurance, are paid after the basic medical insurance claims, so the basic medical insurance claims are well controlled, medical expenses are used reasonably, and business It is helpful to reduce the cost of insurance companies. In fact, the beneficiaries who improve the efficiency of the use of medical insurance funds are undoubtedly the insured persons who really need them. Through the extension and expansion of the functions of the platform service program, the insured personnel can obtain accurate, safe, reliable, efficient and convenient when they seek medical treatment. Service experience, alleviating the dilemma of "difficult to see a doctor, expensive to see a doctor." 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