推进医保数据与医疗数据更好联通

Core Viewpoint - The integration of medical insurance data and healthcare institution data is transforming the relationship between regulatory bodies and healthcare providers from a passive connection to an active collaboration, enhancing both the safety of insurance funds and the quality of medical services [1][2][3]. Group 1: Data Integration and Collaboration - The integration of medical insurance data, which includes information on over 1.3 billion insured individuals, and healthcare data, which encompasses detailed medical records, is crucial for effective governance [2]. - The establishment of a full-chain regulatory system through the connection of insurance settlement data, hospital information systems, and drug traceability data allows for precise oversight by insurance departments [2][3]. - The National Medical Insurance Administration has initiated a new phase of data sharing, requiring local insurance data working groups to regularly disclose fund operation conditions and engage with healthcare institutions [3]. Group 2: Impact on Healthcare Institutions - Healthcare institutions can optimize resource allocation by accessing timely data on insurance payments, patient flow, and drug usage, which was previously unavailable to them [2]. - Data sharing has enabled hospitals to move away from experience-based decision-making to data-driven management, enhancing operational efficiency [3]. - The use of data visualization tools allows healthcare institutions to quickly access their performance metrics and compare them with industry standards, facilitating targeted operational strategies [3]. Group 3: Benefits to Insured Individuals - The ultimate goal of improved data flow and communication between insurance and healthcare sectors is to benefit insured individuals by providing more efficient and compassionate medical services [4].