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。
The prescription must be signed by means of the prescriber by his / her hand. His/her deal with and registration wide variety definitely needs to be ready in the case of perilous and habits-forming medicines.
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。
Turn into. Consequently, as an example, the evaluation / payment agency raises the prescription precedence order of simpler medicines so that a lot of healthcare institutions can prescribe the medicines. Due to this fact, the standard of healthcare products and services plus the fairness of expenses amongst insured individuals Promoted. Also, a rise in prescription of The most cost effective drug between a plurality of drugs acquiring exactly the same outcome can also be obtained, including reduction in drug expenses for insurers and insured folks.
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【選択図】図３[Complications] To offer a process for offering a chance for a healthcare establishment / insurance policy pharmacy to preferentially adopt a drugs that an insured / insurance provider or evaluation / payment establishment really wants to prescribe while in the health-related insurance coverage system. Supplied. [MEANS FOR Resolving Complications] Getting into / Keeping information on alternatives, prescription precedence order information of the insurance company, and conditions / criteria for acceptance of the receipt examination by an evaluation / payment institution for any medication prescribed by an insurance plan professional medical establishment Inquiries relating to whether insurance coverage for prescription drugs is available for Just about every health-related exercise with the indicates and professional medical establishment, and if the inquiries match the required conditions of your insurance company / assessment and payment Group based upon own information for instance signs on the insured Implies to ascertain whether or not the above mentioned inquiry material would not match the specified problems, search for other drugs that meet the specified situations with the drugs specified via the insurance provider based on the insured's information including indicators A method Migraine treatments possessing implies for notifying a health care institution as an alternative and prompting the medical institution to reselect prescription contents. [Variety] Figure three Description
You're taking is a common expression in English. In the past, the sign was imagined to acquire originate with the Jupiter sign. God of healing Jupiter is usually a Greek deity. The impacted individual's rapid Restoration was questioned for through the use of this sign.
) presented with the clinical institution at time of inquiry and information acquired beforehand As well as in genuine-time whether the specified disorders from the insurance company to whom the insured is affiliated and also the examination and payment Corporation in charge are pleased.
If it is set that the required problems are achieved, following, Verify the dealing with position / stock status of prescription drugs from several insurance coverage pharmacies close to the handle from the clinical establishment / insurance provider, and acquire the outcomes. Also supply to clinical establishments. Alternatively, if it is set that the desired problems are usually not met, the prescription recommendation subject derived depending on the insured particular person's information offered because of the clinical institution in just a array that matches the desired circumstances in the examination payer and also the insurer Distribute an index of medicines to clinical institutions and encourage them to reselect.
It truly is composed of assumed health care price factors calculated for every damage and symptom categorized In accordance with case, drug rate common of utilised drugs, insurance points, other facts required for examination of health-related price facts, and many others. Pharmaceutical prescription information inquiry and distribution procedure.
Initial, in FIG. one, the parties connected to the information method of the existing invention are going to be clarified. This information program features a health-related establishment that prescribes prescription drugs to your insured, an insurance policies pharmacy that dispenses prescription drugs determined by a prescription issued from the healthcare institution and offers them to your insured, an insurance provider that bears clinical insurance policy expenses, and An assessment / payment establishment that examines healthcare fee information from professional medical establishments / insurance plan pharmacies is related. Every single celebration presents the information system by using a number of necessary information being described later on.Inside the information procedure, (one) information on options and prescriptions with the insurance provider for drugs prescribed with the insurance plan clinical institution for your insured Enter / keep preferred priority information, (two) Enter / keep disorders / standards for acceptance of receipt critique by review / payment organization, (3) Inquire about availability of insurance for prescription drugs from health-related establishments for every health-related follow Based upon individual information for instance acceptance, insured's symptom, professional medical history, age, and so on.
Even though each line has a definite character, together they type an entire medication selection support Answer, serving a wide array of healthcare marketplaces and providing steady articles and aligned answers encompassing equally drug reference and drug data.
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。