Info system keeps tabs on insurance

Updated: 2011-12-15 07:47

By Wang Qingyun (China Daily)

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Info system keeps tabs on insurance

Doctor Ji Dianshun checks an X-ray of a patient at Taoranting community health service center in Xicheng district, Beijing. Wan Xiang / Xinhua

BEIJING - All hospitals covered by Beijing's medical insurance system have now established hospital information systems, which ensure doctors make correct prescriptions and keep an eye on the use of medical insurance.

Xu Renzhong, head of the medical insurance center under the city's bureau of human resources and social security, said the system gives real-time patient information to the medical insurance center and allows each of the 1,823 hospitals to keep full track of a patient's medical records.

Info system keeps tabs on insurance

Each hospital is linked to a mother-system run by the medical insurance center.

As a result, people covered by the city's medical insurance system can get a certain amount of reimbursement by swiping their social security cards at the hospitals.

The medical insurance center has set standards for the amounts and prices of medicine.

Using the system, medical centers in all 16 districts and counties keep track of the hospitals providing medical insurance reimbursement every day, pick out prescriptions that go over the standards, and notify the hospital that they will disallow the prescription's reimbursement.

"For example, we can find out when somebody repeatedly gets the same prescription in a very short time, or the prescription of a suspicious amount of medicine," said Xu.

"We will check with the hospital if such things occur, and punish those involved in illegal prescription."

The medical insurance center has given warnings to 17 hospitals, punished 20 doctors, and frozen reimbursements for 179 patients.

According to Zhang Dafa, assistant inspector of the city's bureau of human resources and social security, the city's medical insurance fund this year received about 37 billion yuan ($5.8 billion), and has more than 800 million yuan left.

However, Xu said the medical insurance fund should be used with care.

"There are 163,500 people going to see doctors in these hospitals every day on average. It will be a considerable waste of the city's fund if everyone improperly uses the reimbursement. And the system helps in this way."

The coverage of the system is also a concrete step to improving hospital management, said Wang Shan, president of Peking University People's Hospital.

"Before the information system was set up, doctors had to check information about their prescriptions by hand and it is a waste of time," Wang said.

Shang Weiping, a staff member of a medical service center of Xicheng district, said her hospital set up the system four years ago, and so has a detailed health report of its patients.

"The long-term health reports surely help our doctors in diagnosing cases," Shang said.

"The receipts the system gives show how much and on what things I spent my money," said 65-year-old Liu Xuemin.

"I also know how much of my reimbursement quota I have used this year and how much is left. It's very clear."