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。
以下に、図４を用いて情報照会・判定の手順の一例のフローチャートを説明する。まず審査支払機関・保険者・保険医療機関・保険薬局から必要な情報を取得する。審査支払機関及び保険者から取得する情報・指定条件は前述の通りであり、医療機関・保険薬局からは所在地等の基本情報に加え、使用希望薬剤情報・医薬品取扱情報・同在庫情報等を取得し、取得したデータを格納する。
Inside the procedure Procedure phase, the following processing is performed in authentic time. To put it differently, inquiries with regards to the availability of insurance policies coverage for prescription drugs from health treatment institutions are created through communication traces through Each individual health care practice, and these inquiries are as opposed Together with the input information and specified problems with the examination and payment establishments and insurers mentioned previously mentioned. Then, the assessment having to pay establishment and the insurance company identify whether or not to reject the insurance policy software, distribute The end result to the health-related institution, and Exhibit it over the terminal from the health-related institution by an input / output display as proven in FIG. Because of the willpower, Should the content from the inquiry will not conform for the input information and designated conditions of your assessment and payment institution as well as the insurer, a pharmaceutical team gratifying these is searched and recognized and dispersed to your health care establishment.
また、医薬品費用を負担する被保険者・保険者（健康保険組合等）が、効能・価格等の医薬品に関する情報を十分に知らされていない、複数の代替品の存在に関する情報を十分には知らされていない、といった場合が多い。このため、医薬品の選択に際しては医療機関の判断に全面的に委ねており、費用負担者及び需要者としての医薬品選択の権利が行使しにくい状況が生まれている。
請求項１に記載の医薬品処方情報照会・配信システムにおいて、本システムを介して為された一連の照会履歴を審査支払機関及び保険者に配信することを特徴とする医薬品処方情報照会・配信システム。
It truly is an object of your current creation to offer a prescription information inquiry / distribution program for prescription information that allows health care establishments / insurance plan pharmacies to preferentially adopt the choice medicines from other alternate options. 前記課題を解決するための本発明は、以下の各部から構成されることを特徴とする
The medical prescription information inquiry / distribution technique Based on declare one, whereby the health-related prescription is gained from a health care establishment for every medical apply, and insured information (clinical insurance associated information, injuries and ailment) offered within the medical establishment at some time of inquiry.
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From the prescription information inquiry / distribution procedure Based on declare 1, if the prescription medication inquired within the health-related establishment for every clinical exercise satisfies the selected disorders of the insurance company / evaluation / payment institution, the address from the healthcare institution or insured person Drug prescription information inquiry / distribution procedure that accesses and confirms the managing information / inventory information in the drug at numerous insurance policies pharmacies near the pharmacy.
The present invention for resolving the above-stated issues is made up of the subsequent elements. (one) Enter and keep information on substitutes and prescription priority information of insurers for prescribed drugs prescribed by insurance health care establishments for get more info insured persons (2) Enter and keep the disorders and criteria for receipt overview acceptance via the assessment and payment organization (3) Accepting inquiries from health-related institutions pertaining to The provision of insurance for prescription drugs for each healthcare apply, and producing inquiries depending on personalized information like the insured's signs, health-related background, age, etc., and information on (one) and (2) over Judgment is made in real time to ascertain whether the content material satisfies the problems specified through the insurance provider / evaluation and payment establishment (4) If the above mentioned inquiries usually do not fulfill the specified circumstances, search for other drugs that meet up with the specified ailments determined by the insured's information like indications, etcetera. Notify health-related institutions and really encourage them to reselect prescription content material.
It should be produced beneath the supervision inside the professional medical Skilled or in accordance with pharmacopoeia or formulary Directions. It might be very important to fill the containers Using the Prepared compounds. The container has to be Plainly marked by making use of a label.
hold the probably of remaining abused, and which could cause well staying threats from Unfavorable effects if taken improperly,
This A A part of the prescription also functions the power of the drug (the quantity of milligrams, as an example) furthermore the pill, capsule, or other form where your Health treatment provider supplier would like you to definitely unquestionably consider it. A Choose Observe recognized as "Disp" refers to this information about how the drug need to be dispensed.