濟南市城鄉(xiāng)居民醫(yī)療保險管理信息系統(tǒng)的設計與實現(xiàn)
發(fā)布時間：2019-02-26 14:19
【摘要】：當前,我國基本醫(yī)療保障體系由新型農(nóng)村合作醫(yī)療保險、城鎮(zhèn)居民醫(yī)療保險、城鎮(zhèn)職工醫(yī)療保險共同構成。由于頂層設計先天不足,近年來城鄉(xiāng)居民醫(yī)保制度分設造成的管理分散、基金使用效率低、抗風險能力弱等問題日益突顯,這不僅固化了城鄉(xiāng)二元社會結構,更無法體現(xiàn)社會保障的公平性,引起全社會的廣泛關注。為進一步整合城鄉(xiāng)基本醫(yī)療保險管理職能,2013年11月,山東省人民政府出臺相關政策,整合全省城鎮(zhèn)居民基本醫(yī)療保險和新型農(nóng)村合作醫(yī)療,建立全省統(tǒng)一、城鄉(xiāng)一體的居民基本醫(yī)療保險制度,新農(nóng)合職能、編制、人員的管理等整體由原衛(wèi)生部門移交到人力資源社會保障部門。按照省政府的要求,濟南市于2014年6月完成了兩項制度的整合,建立起新的城鄉(xiāng)居民醫(yī)療保險制度,為實現(xiàn)全市城鄉(xiāng)居民醫(yī)保信息化,需在現(xiàn)有城鎮(zhèn)居民醫(yī)保系統(tǒng)基礎上,建設市級集中的城鄉(xiāng)居民醫(yī)療保險管理信息系統(tǒng)。本文設計和實現(xiàn)的濟南市城鄉(xiāng)居民醫(yī)療保險管理信息系統(tǒng)旨在整合全市城鎮(zhèn)居民醫(yī)療和新農(nóng)合業(yè)務,使全市各區(qū)縣城鄉(xiāng)居民醫(yī)療保險在政策、業(yè)務經(jīng)辦、管理決策上實現(xiàn)統(tǒng)一,并確保參保經(jīng)辦等各項數(shù)據(jù)的原始性、真實性、完整性和集成性。通過建設新的醫(yī)療保險管理信息系統(tǒng),實現(xiàn)了參保信息管理(參保人員個人信息、經(jīng)辦機構信息、參保集體信息等)、基金征繳管理(費用單據(jù)、銀行代扣)、特殊業(yè)務管理、醫(yī)療待遇支付、定點醫(yī)療機構管理、定點醫(yī)療機構結算、三大目錄管理、待遇資格認證、查詢統(tǒng)計等業(yè)務功能。濟南市城鄉(xiāng)居民醫(yī)療保險管理信息系統(tǒng)采用人社部規(guī)定的核心平臺三版技術架構和數(shù)據(jù)指標規(guī)范開發(fā),屬于本地化的開發(fā)。本文首先分析了濟南市城鄉(xiāng)居民醫(yī)療保險管理信息系統(tǒng)的背景和意義,以及國內(nèi)外相關系統(tǒng)的研究現(xiàn)狀；其次分析了濟南市城鄉(xiāng)居民醫(yī)療保險管理系統(tǒng)的需求,按照面向對象的軟件工程開發(fā)模式,采用統(tǒng)一建模語言UML對本文系統(tǒng)進行了需求建模分析；然后,基于MVC模式和J2EE平臺體系結構等成熟的關鍵技術,采用B/S/S三層架構,并結合面向服務的架構SOA,對系統(tǒng)進行了整體架構和技術架構兩方面的設計,保證了系統(tǒng)的可伸縮性和可擴展性；在此基礎上,分析了系統(tǒng)的安全架構設計,確定了系統(tǒng)的詳細設計,包括系統(tǒng)功能模塊設計以及數(shù)據(jù)庫設計等；最后,針對濟南本地城鄉(xiāng)居民醫(yī)療保險行業(yè)的業(yè)務特點,對本文提出的醫(yī)療保險管理信息系統(tǒng)進行了本地化的擴展及實現(xiàn),并對系統(tǒng)進行了詳細的測試。
[Abstract]:At present, the basic medical insurance system of our country is composed of the new rural cooperative medical insurance, the urban resident medical insurance and the urban worker medical insurance. Due to the inborn shortage of the top-level design, the decentralized management caused by the separate establishment of the medical insurance system for urban and rural residents in recent years, the low efficiency of fund use and the weak ability to resist risks have become increasingly prominent, which not only solidifies the dual social structure of urban and rural areas. Moreover, the fairness of social security can not be reflected, which has aroused wide concern of the whole society. In order to further integrate the management functions of urban and rural basic medical insurance, in November 2013, the people's Government of Shandong Province issued relevant policies to integrate the basic medical insurance for urban residents of the province and the new type of rural cooperative medical care to establish the unity of the province. The integration of urban and rural residents basic medical insurance system, new agricultural cooperation functions, establishment, personnel management from the original health department to the human resources social security department. In accordance with the request of the provincial government, Jinan completed the integration of the two systems in June 2014, and established a new medical insurance system for urban and rural residents. In order to realize the informatization of urban and rural residents' medical insurance, it is necessary to build on the existing urban and rural residents' medical insurance system. Construction of city-level centralized medical insurance management information system for urban and rural residents. The medical insurance management information system for urban and rural residents in Jinan designed and realized in this paper aims at integrating the medical treatment of urban residents and the new agricultural cooperation business of the whole city, so that the medical insurance of urban and rural residents in all districts and counties of the city can be unified in policy, business management and management decision-making. And ensure the original, authenticity, integrity and integration of all kinds of data. Through the construction of a new medical insurance management information system, we have realized the management of insurance information (personal information of insured personnel, agency information, collective information of insurance), fund collection and management (expense documents, bank withholding), special business management, etc. Medical treatment payment, fixed-point medical institutions management, fixed-point medical institutions settlement, three categories of management, treatment qualification certification, query statistics and other business functions. Jinan city urban and rural residents medical insurance management information system adopts the core platform of the Ministry of Human and Social Affairs three edition technical framework and data index specification development, belongs to the development of localization. Firstly, this paper analyzes the background and significance of medical insurance management information system for urban and rural residents in Jinan, as well as the research status of related systems at home and abroad. Secondly, the demand of Jinan City Medical Insurance Management system is analyzed. According to the object-oriented software engineering development mode, the unified modeling language (UML) is used to model the requirements of the system. Then, based on mature key technologies such as MVC pattern and J2EE platform architecture, B/S/S three-tier architecture and service-oriented architecture SOA, are used to design the overall architecture and technical architecture of the system. Ensure the scalability and scalability of the system; On this basis, the security architecture design of the system is analyzed, and the detailed design of the system is determined, including the design of the system function module and the design of the database. Finally, according to the business characteristics of the local urban and rural residents medical insurance industry in Jinan, the localization of the medical insurance management information system proposed in this paper is extended and implemented, and the system is tested in detail.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：TP311.52
本文編號：2430854
[Abstract]:At present, the basic medical insurance system of our country is composed of the new rural cooperative medical insurance, the urban resident medical insurance and the urban worker medical insurance. Due to the inborn shortage of the top-level design, the decentralized management caused by the separate establishment of the medical insurance system for urban and rural residents in recent years, the low efficiency of fund use and the weak ability to resist risks have become increasingly prominent, which not only solidifies the dual social structure of urban and rural areas. Moreover, the fairness of social security can not be reflected, which has aroused wide concern of the whole society. In order to further integrate the management functions of urban and rural basic medical insurance, in November 2013, the people's Government of Shandong Province issued relevant policies to integrate the basic medical insurance for urban residents of the province and the new type of rural cooperative medical care to establish the unity of the province. The integration of urban and rural residents basic medical insurance system, new agricultural cooperation functions, establishment, personnel management from the original health department to the human resources social security department. In accordance with the request of the provincial government, Jinan completed the integration of the two systems in June 2014, and established a new medical insurance system for urban and rural residents. In order to realize the informatization of urban and rural residents' medical insurance, it is necessary to build on the existing urban and rural residents' medical insurance system. Construction of city-level centralized medical insurance management information system for urban and rural residents. The medical insurance management information system for urban and rural residents in Jinan designed and realized in this paper aims at integrating the medical treatment of urban residents and the new agricultural cooperation business of the whole city, so that the medical insurance of urban and rural residents in all districts and counties of the city can be unified in policy, business management and management decision-making. And ensure the original, authenticity, integrity and integration of all kinds of data. Through the construction of a new medical insurance management information system, we have realized the management of insurance information (personal information of insured personnel, agency information, collective information of insurance), fund collection and management (expense documents, bank withholding), special business management, etc. Medical treatment payment, fixed-point medical institutions management, fixed-point medical institutions settlement, three categories of management, treatment qualification certification, query statistics and other business functions. Jinan city urban and rural residents medical insurance management information system adopts the core platform of the Ministry of Human and Social Affairs three edition technical framework and data index specification development, belongs to the development of localization. Firstly, this paper analyzes the background and significance of medical insurance management information system for urban and rural residents in Jinan, as well as the research status of related systems at home and abroad. Secondly, the demand of Jinan City Medical Insurance Management system is analyzed. According to the object-oriented software engineering development mode, the unified modeling language (UML) is used to model the requirements of the system. Then, based on mature key technologies such as MVC pattern and J2EE platform architecture, B/S/S three-tier architecture and service-oriented architecture SOA, are used to design the overall architecture and technical architecture of the system. Ensure the scalability and scalability of the system; On this basis, the security architecture design of the system is analyzed, and the detailed design of the system is determined, including the design of the system function module and the design of the database. Finally, according to the business characteristics of the local urban and rural residents medical insurance industry in Jinan, the localization of the medical insurance management information system proposed in this paper is extended and implemented, and the system is tested in detail.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：TP311.52
【參考文獻】
相關期刊論文 前1條
1 ;魯城鄉(xiāng)居民醫(yī)保今年并軌[J];中國信息界(e醫(yī)療);2014年01期
，本文編號：2430854
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