そして個々の診療行為毎に医療機関から医薬品処方につき照会を受けると、照会時に医療機関から提示される被保険者情報（医療保険関連情報、傷病・症状等の情報等）と、予め取得した情報とを照合し、被保険者が加入している保険者並びに担当の審査支払機関の指定条件を満たしているか否かをリアルタイムで判定する。
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。
【解決手段】保険医療機関が処方する医薬品について、代替品情報、保険者の処方希望優先順位情報を入力・保持する手段、審査支払機関によるレセプト審査承認のための条件・基準を入力・保持する手段、医療機関から診療行為毎に、処方医薬品の保険適用可否に関する照会を受付け、被保険者の症状等の個人情報に基づき、照会内容が保険者・審査支払機関の指定条件に合致しているか否かを判定する手段、上記照会内容が指定条件に合致していない場合は、保険者が指定する医薬品の中から、症状等の被保険者の情報に基づき指定条件を満たす他の医薬品を検索し代替品として医療機関に通知、医療機関にて処方内容の再選択を促す手段を有するシステム。
Within the system Procedure stage, the following processing is executed in actual time. Put simply, inquiries relating to the availability of insurance policy coverage for prescription drugs from health treatment institutions are created by way of interaction traces through Every single health-related observe, and these inquiries are in comparison Using the enter information and specified circumstances with the examination and payment institutions and insurers talked about higher than. Then, the examination shelling out institution along with the insurance provider figure out whether to reject the coverage software, distribute The end result to the healthcare institution, and Show it within the terminal on the professional medical establishment by an enter / output display screen as demonstrated in FIG. Due to the willpower, If your written content of your inquiry won't conform to your enter information and specified situations from the assessment and payment establishment along with the insurer, a pharmaceutical team gratifying these is searched and recognized and dispersed on the health-related establishment.
従って、本発明の課題は、わが国の医療保険制度の中で、医療サービス受給の公平性を維持しつつ、被保険者・保険者もしくは審査支払機関が、代替品の中から最も強く処方を希望する医薬品を、医療機関・保険薬局が、他の代替品の中から優先的に採用する機会を提供することを可能にさせる、医療用医薬品処方情報照会・配信システムを提供することにある。
Upcoming, the stream where the indicates from the existing creation is executed might be described in time collection with reference to FIG.
customer and the moment it certainly is signed throughout the doctor it ends in getting a lawful doc! Prescriptions are essential for all
The medical prescription information inquiry / distribution technique according to claim 1, wherein the health care prescription is been given from the health-related institution for each health care exercise, and insured information (professional medical insurance coverage relevant information, personal injury and health issues) introduced from the medical establishment at some time of inquiry.
) presented from the medical establishment at enough time of inquiry and information acquired in advance As well as in authentic-time whether the specified disorders on the insurer to whom the insured is affiliated and the evaluation and payment Business in demand are content.
As a result, whilst preserving the fairness of getting health care expert services, the insured / insurance provider / evaluation / payment institution has the opportunity to select a drug that's considered desirable from the viewpoint of effectiveness, price, etcetera. Is not really furnished plenty of. For that reason, the trouble from the existing invention would be that the insured particular person / insurer or assessment / payment institution desires to prescribe the strongest prescription among solutions although maintaining the fairness of obtaining healthcare expert services in Japan's healthcare coverage program.
It really is composed more info of assumed health-related cost details calculated for every harm and symptom categorised In accordance with situation, drug price tag typical of applied drugs, insurance details, other details required for assessment of clinical cost information, and so forth. Pharmaceutical prescription information inquiry and distribution program.
This A part of the prescription includes Guidelines for that pharmacist, from the party of the drug if it should be compounded in the pharmacy.
An example of the configuration of this kind of an information program is proven in FIG. In this example of information system, at least display and output device / input unit / details storage which include everyday pc with conversation indicates mounted in Just about every of evaluation paying establishment, insurer, coverage clinical institution, insurance plan pharmacy Plus a central system that performs information inquiry / perseverance are connected through a interaction line including the online market place.
This A Portion of the prescription also characteristics the energy of the drug (the quantity of milligrams, as an example) furthermore the pill, capsule, or other type through which your Health treatment assistance provider would like you to definitely definitely consider it. A Consider Be aware discovered as "Disp" refers to this information about how the drug need to be dispensed.