【作者】 边永红；

【导师】 郭文明；

【作者基本信息】 北京邮电大学 ， 软件工程， 2011， 硕士

【摘要】 随着信息技术的发展,从政府到百姓,对高效、便利的追求越来越迫切。北京医疗保险通过多年的实践,及参保人群的不断增加,原始的手工报销方式已经不能满足人们的需求。以往参保人看病时,总是要先垫付全部的医疗费用,然后拿着—摞子单据交到单位或社保所,单位转交至医保经办机构,经办工作人员人工审核、录入所有票据,因工作量大,经办人员不堪重负；而参保人员也需经过数月漫长等待,方能拿到报销费用。为了根本解决医疗保险费用手工报销周期长等问题,“北京市医疗保险持卡实时结算”项目的建设应运而生。社保卡系统实现参保人“持卡就医、实时结算”。参保人持卡就医,通过医院HIS系统,实时对接医保经办收缴系统、审核结算系统,仅仅需用十几秒的时间就能完成报销过程。本文给出了卡项目的结算流程,论述了结算方式的改进。重点研究了担负核心功能的收缴系统,分析了收缴系统的整体架构,系统在架构设计阶段中更多在保证系统实时响应方面作了努力,提出了特定的一、二级库分别支持收缴业务与门诊实时结算的方式,以便满足实时结算对系统性能的要求。应对多系统协同作业,研究探讨了面向接口的开发方法,尽可能保证接口的稳定性。保障卡项目,能够解决医疗保险费用手工报销周期长,环节多,参保人员垫付款负担重,经办机构超负荷工作等问题。更多还原

【Abstract】 With the development of information technology, from government to the people, pursuit of efficiency and convenience have become more urgent. At the same time, after many years of practice, the insured population greatly increased in the Beijing Medical Insurance. Manual payment is no longer meeting the current situation.When the insured person to see a doctor, always advance all the medical expenses first, and then took a lot of receipts submitted to the company, after a long wait for a few months in order to get reimbursed.In order to reduce long period of handing to pay for medical insurance, the project of "Beijing Social Security card" emerged as the times require. Social security card system makes the insurance people to use cards for medical treatment, real-time payment. Insured person for medical treatment, through the hospital HIS system, real-time access medical payment systems and audit collection system, only ten seconds of the time required to complete reimbursement process. This article discusses the process of payment card project and research the overall architecture for the collection system. More in the architecture design of the system ensuring the system has done to real-time response, to meet the performance requirements Independent databases are designed to support real-time payment business and collection business.In order to adapt the work of multi-system cooperation, study the development of methods for the interface as possible to ensure the stability of the interface. Social security card program, solve the following issues as medical insurance to pay for a long time, complex process. Real-time payment can reduce the burden of insured advances and reduce the workload of the Audit Department.更多还原