医療機関による医薬品の処方に際しては、被保険者（患者）が保健医療機関で医師の診察を受け、その診断結果をもとに医師が処方箋を発行、同処方箋に基づき保険薬局にて医薬品が調剤、提供される、という流れになっている。保険が適用される医薬品の費用請求については、被保険者による一部費用負担を除くと、医療機関・保険薬局などが、レセプトと呼ばれる診療報酬明細書に、診療、検査、投薬、手術など医療行為の内容を記入し、月ごとに審査支払機関に提出、医療費を請求する。審査は、社会保険診療報酬支払基金と都道府県支部、国民健康保険中央会と各都道府県の国民健康保険団体連合会にて実施され、かかった医療費をそのまま医療保険から支払う「出来高払い制」を採用されている。
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。
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。
In the system Procedure stage, the following processing is executed in authentic time. Basically, inquiries pertaining to The supply of insurance coverage protection for prescription drugs from health care establishments are made via conversation strains through Each and every medical exercise, and these inquiries are in contrast with the input information and specified disorders in the assessment and payment institutions and insurers pointed out higher than. Then, the examination paying out establishment and also the insurance company identify whether or not to reject the insurance policies software, distribute The end result to your medical institution, and Show it within the terminal on the clinical establishment by an enter / output display screen as demonstrated in FIG. Due to the perseverance, Should the content from the inquiry will not conform on the input information and designated conditions of your assessment and payment institution and also the insurer, a pharmaceutical team gratifying these is searched and recognized and dispersed for the healthcare establishment.
Turn out to be. As a result, such as, the examination / payment company raises the prescription precedence order of simpler medicines so that numerous health care establishments can prescribe the medicines. Consequently, the standard of healthcare expert services and also the fairness of expenditures among insured individuals Promoted. Also, a rise in prescription of the cheapest drug amongst a plurality of drugs obtaining the same impact can be received, for instance reduction in drug prices for insurers and insured folks.
Up coming, the movement by which the indicates from the current invention is executed is going to be explained in time series with reference to FIG.
【選択図】図３[Issues] To offer a procedure for delivering a possibility for a health care establishment / coverage pharmacy to preferentially adopt a medicine that an insured / insurer or examination / payment institution really wants to prescribe from the health-related insurance policies procedure. Delivered. [Indicates FOR SOLVING Issues] Entering / Keeping information on possibilities, prescription precedence order information of an insurer, and circumstances / requirements for acceptance of the receipt examination by an examination / payment establishment for the medicine prescribed by an insurance professional medical institution Inquiries concerning regardless of whether insurance coverage for prescription drugs is obtainable for Every single healthcare observe through the indicates and professional medical institution, and if the inquiries match the required situations with the insurer / evaluation and payment Corporation according to particular information such as indicators of your insured Implies to find out whether the above mentioned inquiry written content doesn't match the specified problems, try to find other drugs that fulfill the required conditions from the drugs specified from the insurer according to the insured's information including indicators A technique obtaining implies for notifying a health-related institution instead and prompting the professional medical establishment to reselect prescription contents. [Collection] Figure 3 Description
You're taking is a common expression in English. In the past, the sign was imagined to obtain originate within the Jupiter signal. God of therapeutic Jupiter can be a Greek deity. The affected particular person's speedy Restoration was questioned for by utilizing this sign.
Choose a default timezone, and allow properly remaining understanding syncs and placement specifics. This past ingredient is crucial for someone making an attempt to cope with indications connected to their community weather conditions and pollen.
If it is set that the required problems are achieved, up coming, Look at the handling standing / stock position of prescription drugs towards many insurance coverage pharmacies near the tackle of the health-related establishment / insurance provider, and acquire the results. Also provide to health care institutions. On the other hand, if it is determined that the specified problems are usually not satisfied, the prescription recommendation matter derived based upon the insured human being's information introduced via the professional medical establishment in a selection that matches the specified conditions of the assessment payer along with the insurer Distribute a list of medicines to professional medical institutions and inspire them to reselect.
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。
Very first, in FIG. 1, the events connected to the information program on the current invention will likely be clarified. This information program includes a medical establishment that prescribes prescribed drugs on the insured, an insurance policies pharmacy that dispenses prescribed drugs depending on a prescription issued from the healthcare establishment and gives them towards the insured, an insurance provider that bears health care insurance policy costs, read more and An assessment / payment institution that examines clinical payment aspects from health care establishments / insurance policies pharmacies is related. Every single party supplies the information system having a number of necessary information for being explained afterwards.Within the information technique, (one) information on alternatives and prescriptions from the insurance company for drugs prescribed by the insurance policy clinical establishment with the insured Enter / hold wanted priority information, (2) Enter / hold circumstances / specifications for approval of receipt evaluation by overview / payment Firm, (3) Inquire about availability of insurance coverage for prescription drugs from healthcare institutions for every health care follow Depending on private information like acceptance, insured's symptom, medical record, age, and so forth.
While Every single line has a definite character, together they kind an entire medication choice support Option, serving a big range of healthcare marketplaces and providing regular written content and aligned options encompassing equally drug reference and drug facts.
Should your healthcare medical doctor requirements the pharmacist to provide you with a particular brand of medication, they've got to exactly Observe this or sign-up the space shipped.