Even though the execution with the indicates from the current invention is performed by way of an information method, this execution is approximately divided into two stages: a technique preparing phase and an operation stage.
・ It is not intended to increase the selections for pharmaceuticals of insurers and lessen the expense of pharmaceuticals. Furthermore, PBM in The us gives drug Charge administration expert services for corporations including businesses as the leading customers and won't go over all citizens. is not.
以下に、図４を用いて情報照会・判定の手順の一例のフローチャートを説明する。まず審査支払機関・保険者・保険医療機関・保険薬局から必要な情報を取得する。審査支払機関及び保険者から取得する情報・指定条件は前述の通りであり、医療機関・保険薬局からは所在地等の基本情報に加え、使用希望薬剤情報・医薬品取扱情報・同在庫情報等を取得し、取得したデータを格納する。
医療機関からの照会後、処方医薬品を確定した段階で医療機関から最終の処方内容が情報システムに送信される。保険薬局から処方箋記載の医薬品の保険適用の可否について照会があった場合には、医療機関との照会履歴の有無、結果を配信する。
また、医薬品費用を負担する被保険者・保険者（健康保険組合等）が、効能・価格等の医薬品に関する情報を十分に知らされていない、複数の代替品の存在に関する情報を十分には知らされていない、といった場合が多い。このため、医薬品の選択に際しては医療機関の判断に全面的に委ねており、費用負担者及び需要者としての医薬品選択の権利が行使しにくい状況が生まれている。
The central process includes a calculation device, a Show and output device, an input unit, and a data storage unit. An illustration of a data file being referred to at the time of calculation is shown in FIG.
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Inside the planning stage of your system, the assessment payer plus the insurer enter necessary information and specify situations. Examples of information entered because of the evaluation payer as well as insurance company and the desired ailments are depending on information within the insurer matter to assessment, problems like the insured's age, gender, Structure and earlier history You will find assumed professional medical fee details calculated for each particular person sickness and symptom divided, drug price tag expectations of used drugs, insurance policies factors, along with other knowledge demanded for evaluation of health-related fee specifics.
) presented because of the health-related establishment at time of inquiry and information acquired in advance And in real-time whether or not the specified disorders of the insurance provider to whom the insured is affiliated as well as the assessment and payment Corporation in cost are happy.
Due to this fact, even though maintaining the fairness of acquiring medical solutions, the insured / insurance company / assessment / payment institution has the chance to select a drug that is considered attractive through the viewpoint of efficiency, rate, etcetera. Just isn't presented adequate. For that reason, the situation of your current invention is that the insured individual / insurance company or evaluation / payment establishment would like to prescribe the strongest prescription among the possibilities though retaining the fairness of getting professional medical solutions in Japan's medical insurance policies method.
The present creation for resolving the above-stated troubles is composed of the subsequent sections. (one) Enter and hold information on substitutes and prescription priority information of insurers for prescribed drugs prescribed by coverage health care institutions for insured individuals (2) Enter and manage the conditions and standards for receipt assessment acceptance via the assessment and payment Group (three) Accepting inquiries from professional medical establishments relating to The provision of insurance for prescription drugs for every clinical apply, and generating inquiries based on particular information like the insured's indicators, professional medical record, age, etc., and information on (1) and (two) previously mentioned Judgment is manufactured in genuine time to ascertain whether or not the material meets the problems specified because of the insurer / evaluation and payment institution (four) If the above inquiries tend not to fulfill the specified disorders, seek for other drugs that satisfy the required circumstances dependant on the insured's information for instance signs, etcetera. Notify professional medical institutions and persuade them to reselect prescription written content.
Hereinafter, a flowchart of an illustration of an information inquiry / willpower course of action are going to be explained with reference to FIG. Very first, the mandatory information is attained with the examination payer / insurance company / insurance policies clinical establishment / insurance pharmacy. The information and specified circumstances for being received through the evaluation payer along with the insurer more info are as described above.
When Just about every line has a definite character, with each other they kind a whole medication choice support Option, serving a wide array of healthcare marketplaces and providing dependable content material and aligned methods encompassing both equally drug reference and drug information.
最後に、一連の照会履歴を審査支払機関及び保険者に配信し、情報照会・判定の手順を終了する。