患者信用大数据背景下医保创新应用及监管研究

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中图分类号：F840.684；TP311.13

文献标志码：A 文章编码：1672-7274（2025）05-0038-03

Abstract： To solve the problems of incomplete patient credit system，single medical insurance payment methods， and unreasonable medical treatment process under the "diagnosis and treatment before payment" medical treatment model. This paper uses technologies such as big data mining and deep learning to collect and process patient basic information，medical insurance payments，clinical diagnosis and treatment data，establisha medical insurance big data cloud service platform，and build a unified standard medical insurance credit system. Result： By using the medical insurance credit rating evaluation model， medical insurance behavior supervision model， medical insurance cost control model，and medical insurance treatment behavir predictionand recommendation model，the cognitive and judgmentabilitiesof medical insurancecostcontrol have beenimproved，providingafoundation forinnovative applications of medical insurance.The "diagnosis and treatment before payment" model based on the medical insurance credit system has changed thetraditionalmedical treatment processinhospitals，allowing patients to receive more intuitiveandconvenient medical services，and has played a very positive role in improving patient satisfaction with medical treatment.

Keywords： medical insurance credit payment; big data; diagnosis and treatment before payment

“看病难、看病贵”已成为医疗领域存在的主要社会矛盾。（剩余3166字）