STRUCTURE, PROCESS, EFFECTIVENESS AND EFFICIENCY OF THE CHECK AND REVIEW SYSTEM IN JAPAN HEALTH-INSURANCE
STRUCTURE, PROCESS, EFFECTIVENESS AND EFFICIENCY OF THE CHECK AND REVIEW SYSTEM IN JAPAN HEALTH-INSURANCE
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DOI：
10.1016/0168-8510(91)90010-u
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发表时间：
1991-12-01
期刊：
影响因子：
3.3
通讯作者：
YANO, E
中科院分区：
文献类型：
--
作者：
KOBAYASHI, Y;YANO, E
将医疗费用保持在适当和可负担的水平，仅靠医疗设施的努力是无法实现的，也不能通过修改日本健康保险系统的收费表和药品价格表来实现。 必须使所有系统，包括各保险组织和审查及支付组织，实现标准化并提高其效率。 本文首先考察了日本健康保险制度下的保险索赔审查和支付制度，重点是（1）资格审查，（2）保险索赔的审查和审查，（3）审查程序的计算机化。 然后讨论了检查和审查系统面临的相关问题。
Keeping medical costs at an adequate and affordable level cannot be realized by the efforts of medical facilities alone, nor by the revision of fee schedules and price schedules of drugs in Japan's health insurance systems. Rationalization and improvement in the efficiency of all of the systems, including the various insurance organizations and the organizations for review and payment, are imperative. This paper first examines the system of review and payment for insurance claims under Japan's health insurance systems with emphasis on three main points, namely (1) qualification checks, (2) check and review of insurance claims and (3) computerization of the screening process. Relevant issues facing the check and review system are then discussed.