本文選題：新農(nóng)合 + 商業(yè)保險　； 參考：《山東大學》2014年碩士論文

【摘要】：新型農(nóng)村合作醫(yī)療,簡稱新農(nóng)合,是一項覆蓋我國城鄉(xiāng)農(nóng)民醫(yī)療保障的重要制度。隨著信息科學發(fā)展的日新月異,計算機技術(shù)也已廣泛應用到了新農(nóng)合領(lǐng)域中,信息化建設(shè)是新型農(nóng)村合作醫(yī)療事業(yè)有效開展,實現(xiàn)科學管理的重要手段。黨中央從試點運行時就非常重視新農(nóng)合的信息化建設(shè),從政策、規(guī)范制定以及資金投入等多方面加大投入力度。隨著商業(yè)保險的加入,一方面新型農(nóng)村合作醫(yī)療制度得到了補充和完善；另一方面新農(nóng)合信息化建設(shè)也遇到了挑戰(zhàn),如何實現(xiàn)商業(yè)保險系統(tǒng)與新農(nóng)合系統(tǒng)之間的無縫對接,業(yè)務(wù)流程的優(yōu)化承接,同時又能保證雙方的信息安全對新農(nóng)合大病保險業(yè)務(wù)的長遠發(fā)展至關(guān)重要。 本文對比國內(nèi)新農(nóng)合信息系統(tǒng)發(fā)展概況,結(jié)合業(yè)務(wù)流程優(yōu)化和基于視圖的需求分析方法在信息系統(tǒng)中的應用,在商業(yè)保險參與新農(nóng)合大病保險的政策背景下,以如何實現(xiàn)XX市商業(yè)保險公司與新農(nóng)合之間的信息系統(tǒng)對接為研究對象。在研究的過程中,通過分析新農(nóng)合系統(tǒng)與商業(yè)保險系統(tǒng)現(xiàn)狀,并根據(jù)衛(wèi)生系統(tǒng)和保險行業(yè)各自的行業(yè)特點,包括雙方各自對信息系統(tǒng)功能、性能和安全性等多方面的綜合需求,設(shè)計了解決方案。 本文首先進行系統(tǒng)分析,對參合農(nóng)民在定點醫(yī)療機構(gòu)實現(xiàn)大病保險出院即報,在縣區(qū)新農(nóng)合網(wǎng)點實現(xiàn)域外就醫(yī)后的非出院即報,以及商業(yè)保險公司內(nèi)部如何接收數(shù)據(jù),最終實現(xiàn)大病保險結(jié)算支付的整體流程進行了梳理和分析。在系統(tǒng)設(shè)計的過程中,本文列舉了系統(tǒng)建設(shè)的總體設(shè)計原則,以此為基礎(chǔ)對系統(tǒng)功能結(jié)構(gòu)以及信息系統(tǒng)流程進行了分析與設(shè)計,并詳細闡述了系統(tǒng)對接模式的設(shè)計思路；最后,從系統(tǒng)實施的角度出發(fā),介紹了項目開展過程中有關(guān)項目管理方面的實施要點,并針對一些與信息系統(tǒng)建設(shè)有關(guān)的實際問題,例如在支付轉(zhuǎn)賬過程中,縣區(qū)農(nóng)民的銀行卡普及率低等問題進行了分析并給出了建議。商業(yè)保險參與新農(nóng)合醫(yī)療保障,是對新型農(nóng)村合作醫(yī)療制度的一項重要補充,而科學、合理的設(shè)計信息系統(tǒng)對接,是促進政策有效開展的前提。希望本文的內(nèi)容,能為今后新農(nóng)合大病保險信息系統(tǒng)建設(shè)的發(fā)展起到微薄的參考作用,貢獻一份力量。
[Abstract]:The New Rural Cooperative Medical system (NCMS) is an important system covering rural and urban farmers' medical security.With the rapid development of information science, computer technology has been widely used in the field of new agricultural cooperation. Information construction is an important means of effective development and scientific management of the new rural cooperative medical system.The Party Central Committee has attached great importance to the informatization construction of NCMS from the point of view of pilot operation, and has increased its input from many aspects, such as policy, standard formulation and capital input.With the entry of commercial insurance, on the one hand, the new rural cooperative medical system has been supplemented and improved; on the other hand, the information construction of the new rural cooperative medical system has also encountered challenges, how to realize the seamless docking between the commercial insurance system and the new rural cooperative medical system.At the same time, the information security of both sides is very important to the long-term development of NCMS insurance business.In this paper, the general situation of the development of NCMS information system in China, the application of business process optimization and view-based requirement analysis method in the information system, and the policy background of commercial insurance participating in NCMS insurance are discussed.How to realize the information system docking between XX commercial insurance company and NCMS is the research object.In the course of the research, by analyzing the current situation of the new agricultural cooperative system and the commercial insurance system, and according to the respective industry characteristics of the health system and the insurance industry, including the comprehensive needs of both sides for the function, performance and security of the information system,The solution is designed.This article first carries on the systematic analysis, reports that the participating farmers realize the serious illness insurance and discharge immediately in the designated medical institution, and how to receive the data inside the commercial insurance company after the new rural cooperative network in the county and district realizes the non-discharge report after the outside medical treatment, and how to receive the data inside the commercial insurance company.Finally, the overall process of realizing the settlement and payment of serious illness insurance has been combed and analyzed.In the process of system design, this paper enumerates the general design principles of system construction, analyzes and designs the system function structure and information system flow, and expounds the design idea of system docking mode in detail.From the point of view of system implementation, this paper introduces the key points of project management in the process of project development, and aims at some practical problems related to the construction of information system, such as in the process of payment and transfer.This paper analyzes the problems of low popularization rate of bank cards of farmers in county areas and gives some suggestions.The participation of commercial insurance in the new rural cooperative medical system is an important supplement to the new rural cooperative medical system, and the scientific and reasonable design of information system is the premise to promote the effective development of the policy.It is hoped that the content of this paper will play a reference role and contribute to the development of the new NCMS insurance information system in the future.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：F842.684;R197.3;F842.3

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