Information management and effectiveness evaluation of medical insurance limited-payment drugs
Objective To reduce the refusal of medical insurance for limited-payment drugs based on informatization control and promote the rational use of drugs.Methods Based on Prescription Automatic Screening System,structured rules for limited-payment drugs were formulated for review,and the relevant data of medical insurance review of outpatient prescriptions from September 2021 to June 2024 were collected for descriptive statistical analysis.Results After the implementation of customized medical insurance review rules,the number of rule entries has been increasing year by year,leading to a rise in the system's rate of unreasonable reviews.The highest rate of unreasonable reviews occurred in 2022,reaching 0.49%,while in 2024,the rate became relatively stable at 0.47%in 2024.Contrary to expectations,the monthly frequency and amount of intercepted cases did not decrease over time following the establishment of the rules;instead,they exhibited an upward trend.As of June 2024,the average monthly interception was 1,075 times and the average monthly interception was 494,900 yuan.Conclusion Informatization control is effective and necessary to promote the rational use of limited-payment drugs.The hospital establishes the linkage among medical insurance,medical treatment and medicine to improve the accuracy of medication review.
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