The current means of controlling fees relies heavily on manual labor, and the technology is relatively outdated and monolithic, so the audit is not comprehensive and thorough enough. However, with the development of big data technology, there has been the emergence of three-party supervision platforms such as Digital Link Econet, who conduct intelligent auditing, supervision and decision-making of the medical insurance fund through more advanced big data means, which greatly improves the detection and resolution of fraudulent insurance fraud.
Contradictions that need to be resolved:
1, the problem of hospital data information silos, whether or not you can break through the information barriers, has become the key to the big data health insurance control.
2, the problem of data information security; just recently broke out Jingdong information leakage problem. Some big data companies will desensitize the data to ensure information security.
3, the current national health insurance system is not yet networked, so the foreign settlement type of fraudulent insurance events occur frequently. Digital Union Econo has explained that through the big data for the filer to carry out multi-dimensional behavioral analysis can be found part of the fraudulent insurance events, but the solution to the settlement of foreign medical settlement is still very urgent.
Impact: the main thing is to reduce the loss of health insurance fund, and really realize the people to use for the people. In addition, the big data health insurance charge control auxiliary decision-making function can also help the health insurance fund decision-makers to develop a scientific health insurance policy.