plus the information in (1) and (two) previously mentioned, whether or not the inquiry written content fulfills the required problems in the insurance provider / evaluation / payment in real time (4) If the above mentioned inquiries don't match the required circumstances, try to find other drugs that meet up with the required problems based on the insured's information for example symptoms from your drugs specified because of the insurance provider. Notify health-related institutions in its place, Prompting reselection prescription at motor functioning this sort of process, promptly and competently, the selection of formulation medicament, for the possibility of insurance policy coverage, accomplish consensus amongst the events.
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。
【解決手段】保険医療機関が処方する医薬品について、代替品情報、保険者の処方希望優先順位情報を入力・保持する手段、審査支払機関によるレセプト審査承認のための条件・基準を入力・保持する手段、医療機関から診療行為毎に、処方医薬品の保険適用可否に関する照会を受付け、被保険者の症状等の個人情報に基づき、照会内容が保険者・審査支払機関の指定条件に合致しているか否かを判定する手段、上記照会内容が指定条件に合致していない場合は、保険者が指定する医薬品の中から、症状等の被保険者の情報に基づき指定条件を満たす他の医薬品を検索し代替品として医療機関に通知、医療機関にて処方内容の再選択を促す手段を有するシステム。
In the system Procedure phase, the next processing is carried out in actual time. Quite simply, inquiries about The provision of coverage coverage for prescription drugs from health treatment establishments are created by means of conversation strains all through Just about every health care exercise, and these inquiries are in comparison Using the enter information and specified circumstances of your examination and payment establishments and insurers mentioned earlier mentioned. Then, the assessment paying out establishment and also the insurance provider decide whether to reject the insurance application, distribute the result on the medical institution, and Show it about the terminal with the medical institution by an input / output screen as proven in FIG. Because of the willpower, If your written content of the inquiry does not conform to the enter information and specified problems on the evaluation and payment institution and the insurance provider, a pharmaceutical group fulfilling these is searched and identified and dispersed for the health-related establishment.
Develop into. Subsequently, by way of example, the examination / payment company raises the prescription priority order of simpler medicines so that a lot of medical institutions can prescribe the medicines. As a result, the caliber of medical companies as well as the fairness of prices amongst insured people Promoted. In addition, an increase in prescription of The most affordable drug among the a plurality of drugs possessing a similar impact can be received, which include reduction in drug costs for insurers and insured people.
請求項１に記載の医薬品処方情報照会・配信システムにおいて、本システムを介して為された一連の照会履歴を審査支払機関及び保険者に配信することを特徴とする医薬品処方情報照会・配信システム。
Each time a prescription recommended drugs is selected by a clinical institution, the dealing with position / inventory standing read more at a close-by insurance policies pharmacy is confirmed and The end result is notified.
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The pharmaceutical prescription information inquiry / distribution process according to declare one, wherein a series of inquiry histories made through the procedure is distributed to an evaluation payment Group and an insurer.
図１は、本発明の医薬品処方情報照会・配信方法を活用したビジネスモデルの一例の概略を示す図面であり、図２は、当該ビジネスモデルをより具体的に示す図面であり、図３は、情報システム構成の一例を示す図面であり、図４は、情報照会・判定の一例を示すフローチャートであり、図５は、本発明の医薬品処方情報照会・配信のための情報システム内のデータファイルの一例を示す図面であり、図６は、当該情報システムと接続した医療機関の端末の入出力イメージの一例を示す図である。
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An example of the configuration of this kind of an information program is demonstrated in FIG. In this example of information program, at the least Exhibit and output device / input unit / data storage such as normal personal computer with communication means mounted in Each individual of evaluation paying out institution, insurance provider, insurance plan clinical institution, insurance pharmacy In addition to a central process that performs information inquiry / willpower are connected by means of a communication line including the web.
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