) presented via the professional medical establishment at time of inquiry and information acquired in advance As well as in true-time whether the specified disorders on the insurer to whom the insured is affiliated and the evaluation and payment Business in demand are content.
結果として、医療サービス受給の公平性を保ちつつ、代替品が存在する医薬品の中で、被保険者・保険者や審査支払機関が、効果・価格等の観点から望ましいと考える医薬品を選択する機会が十分に提供されていない。
本発明により、医薬品流通市場における、医療機関・保険薬局といった供給者・処方者と、審査支払機関・保険者・被保険者といった需要者の間で、医療用医薬品の処方・購入に関わる取引に関しリアルタイムに当事者間の合意形成の有無を明確にすることが可能となる。これにより、審査支払機関・保険者は医薬品選択に関わる実効的な意思表示の機会を得ることとなり、自らが希望する医薬品処方につき選択肢が拡大、満足度・費用対効果を向上させることが可能となる。これにより、例えば、審査支払機関がより効能の高い医薬品の処方優先順位を上げることで多くの医療機関で当該医薬品が処方され、結果として被保険者間の医療サービスの質やコストの公平性が促進される。また、同等の効能を持つ複数の医薬品の中で最も安価の医薬品の処方が増加することによる保険者・被保険者の医薬品費用の低減、といった効果も得られる。
Hereinafter, a flowchart of the illustration of an information inquiry / perseverance technique are going to be explained with reference to FIG. Initially, the required information is acquired from your examination payer / insurer / insurance healthcare establishment / insurance plan pharmacy. The information and specified circumstances to generally be received in the assessment payer plus the insurer are as explained over.
In the technique Procedure phase, the following processing is carried out in serious time. To put it differently, inquiries about the availability of insurance policies protection for prescription drugs from health treatment establishments are created by using interaction strains during Each and every health-related follow, and these inquiries are in comparison While using the enter information and specified ailments of your assessment and payment establishments and insurers described previously mentioned. Then, the examination having to pay institution and also the insurer determine if to reject the insurance plan application, distribute The end result to your health care institution, and Display screen it about the terminal in the medical institution by an input / output display screen as proven in FIG. As a result of the perseverance, if the information in the inquiry would not conform on the enter information and designated problems of your examination and payment institution as well as insurer, a pharmaceutical group fulfilling these is searched and discovered and dispersed towards the health care establishment.
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The prescription information inquiry / distribution method In line with assert one, accepting inquiries from insurance plan pharmacies for coverage protection of prescription drugs explained in prescriptions issued by professional medical establishments, and existence of inquiry record with prescription issuing professional medical establishments Pharmaceutical prescription information inquiry and distribution process characterised by distributing benefits.
【選択図】図３[PROBLEMS] To deliver a technique for delivering an opportunity for a professional medical institution / insurance pharmacy to preferentially undertake a medicine that an insured / insurance company or examination / payment establishment wishes to prescribe within the healthcare insurance technique. Supplied. [Suggests FOR SOLVING Troubles] Moving into / holding information on alternate options, prescription precedence order information of the insurer, and problems / standards for approval of a receipt evaluation by an evaluation / payment establishment for just a medicine prescribed by an insurance policy clinical establishment Inquiries about no matter whether insurance plan for prescription drugs is obtainable for each healthcare apply in the implies and health-related institution, and whether or not the inquiries match the required ailments on the insurance company / examination and payment Corporation based upon personalized information including signs and symptoms of the insured Suggests to determine whether the above inquiry information will not match the required problems, look for other drugs that meet up with the specified problems from the drugs specified because of the insurer determined by the insured's information which include signs A procedure getting signifies for notifying a professional medical institution in its place and prompting the health-related establishment to reselect prescription contents. [Choice] Figure 3 Description
This A Section of the prescription also features the energy of your drug (the amount of milligrams, for example) moreover the tablet, capsule, or other kind where your Health treatment services supplier would love you to definitely definitely consider it. A Get Observe discovered as "Disp" refers to this information regarding how the drug should be dispensed.
Moreover, the examination and payment establishment plus the insurance provider will specify the medicines that they want to preferentially prescribe. The designation method is as follows: (one) Specify the name of a selected group of drugs for every injuries and symptom classified according to several problems including the insured's age, gender, constitution and medical heritage. Or use (two) the upper Restrict with the healthcare remuneration rating / utilized drug coverage score and allow the prescription with the drug so long as the upper Restrict is not really exceeded. These input information and specified situations are saved as details within the information process.
The clinical prescription information inquiry / distribution program As outlined by declare one, wherein the medical prescription is been given from the clinical institution for every health care follow, and insured information (health care insurance policy connected information, damage and health issues) offered from your medical establishment at time of inquiry.
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From the planning stage from the system, the assessment payer along with the insurer enter necessary information and specify disorders. Examples of information entered with the examination payer plus the insurance provider and the required conditions are based on information around the insurer subject to assessment, ailments like the insured's age, gender, constitution and past history You can find assumed health care rate factors calculated for every particular person sickness and symptom divided, drug selling price expectations of utilized drugs, insurance coverage points, and various facts necessary for assessment of health-related fee information.