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 标    题: 大数据对于国家治理体系的重塑——以疾病诊断分组制改进为例(创刊号)(2022 第1卷 第1期 4)
作       者

燕继荣,韩坤

文章栏目:
智慧城市
摘       要: 普遍认为,大数据技术的应用改善国家治理状况,但它究竟如何影响国家治理绩效依然值得深入探究。本文通过考察大数据在疾病诊断分组制改进中的作用,分析大数据的价值及其重塑国家治理体系的作用。疾病诊断分组是建立在大量数据的基础上的,过往医疗数据的数量不足,质量不高,影响疾病诊断分组发展。随着数据标准的统一以及大数据存储清洗、分析挖掘、安全隐私保护等关键技术的实现,海量数据被有效利用,数据实现互联互通,信息孤岛被拆除。案例显示,大数据技术为商业健康险企业提供精算与风控需要的数据基础,使企业、社会能够参与治理;大数据技术推动建立基于临床全样本数据的病种组合目录库,使不同疾病组的收费价格及统筹基金的支付比例完全透明公开,提高了公众的监督力度;大数据技术使医保基金使用更加规范,医疗成本得以降低,让医保控费得以实现。疾病诊断分组改进体现了大数据如何在治理主体、治理过程和治理结果方面重塑了医疗体系,证明大数据技术至少在治理主体实现协同治理、治理过程实现有效监督、治理结果实现成本控制三个方面倒逼和推动国家治理体系的重塑。
关  键  词:
大数据;国家治理体系;健康医疗;疾病诊断分组
Abstract: Although it is generally acknowledged that the use of big data technology enhances national governance, greater research into how it truly influences national government performance is still necessary. This study examines the utility of big data and how it can improve disease diagnosis grouping systems in order to analyze how big data can alter national government structures. The development of diagnostic disease grouping has been hampered by the lack of sufficient and high-quality medical data in the past. Diagnostic disease grouping is based on a vast amount of data. With the implementation of key technologies like big data storage and cleaning, analysis and mining, as well as security and privacy protection, enormous amounts of data are being used effectively thanks to the harmonisation of data standards, which has enabled the interconnection of data and the dismantling of information silos. The case demonstrates that, first, how big data technology gives commercial health insurance companies access to the data base required for actuarial and risk management, enabling businesses and society to participate in governance. second, big data technology encourages the establishment of a catalogue library of disease combinations based on full clinical sample data, enhancing public oversight by making the rates charged for various disease groups and the payment percentage of the coordination fund entirely transparent and open. third, big data technology has made it possible to cut medical expenditures, standardize the use of health insurance funds, and keep health insurance costs under control. The improvement of disease diagnosis grouping demonstrates how big data has transformed the healthcare system in terms of governance subjects, governance processes, and governance outcomes, demonstrating that big data technology has encouraged the transformation of the national governance system in at least three areas: collaborative governance of governance subjects, efficient supervision of governance processes, and cost control of governance outcomes.
Keywords: Big Data,National Governance Systems,Medical and Health Care,DRGs
作者简介:

燕继荣,北京大学政府管理学院政治学教授、院长,北京大学国家治理研究院研究员,北京大学公共治理研究所所长,Email: yan8866@pku.edu.cn;

韩坤(通讯作者),北京大学政府管理学院政治学博士研究生,Email: hankun@stu.pku.edu.cn。

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