) introduced by the medical establishment at time of inquiry and information obtained ahead of time And in genuine-time if the desired disorders with the insurance company to whom the insured is affiliated and also the assessment and payment Business in charge are satisfied.
Initial, in FIG. 1, the parties linked to the information procedure of your current invention will probably be clarified. This information method includes a professional medical establishment that prescribes prescription drugs into the insured, an insurance pharmacy that dispenses prescription drugs based upon a prescription issued by the professional medical institution and offers them into the insured, an insurance company that bears health care insurance policy expenses, and An evaluation / payment institution that examines health care charge aspects from health care establishments / insurance policy pharmacies is related. Each individual bash gives the information procedure using a number of essential information being explained afterwards.Within the information technique, (one) information on choices and prescriptions with the insurance provider for drugs prescribed by the insurance policies health-related establishment with the insured Enter / maintain wished-for precedence information, (two) Enter / keep conditions / specifications for approval of receipt critique by critique / payment Group, (3) Inquire about availability of insurance policies for prescription drugs from health care institutions for each medical observe Based upon personalized information including acceptance, insured's symptom, health care background, age, etc.
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。
plus the information in (one) and (two) previously mentioned, if the inquiry content fulfills the required circumstances from the insurance company / assessment / payment in real time (4) If the above inquiries don't match the desired ailments, search for other drugs that meet the specified situations determined by the insured's information for instance signs and symptoms through the drugs specified from the insurance company. Notify medical institutions in its place, Prompting reselection prescription at motor operating these process, rapidly and successfully, the selection of formulation medicament, for the potential for insurance policy coverage, attain consensus in between the parties.
In the technique Procedure stage, the next processing is carried out in serious time. Quite simply, inquiries about the availability of insurance policies protection for prescription drugs from health treatment establishments are created by using communication lines for the duration of Just about every healthcare apply, and these inquiries are in comparison with the enter information and specified disorders of the assessment and payment establishments and insurers stated earlier mentioned. Then, the evaluation paying out institution and the insurer identify whether to reject the insurance policies application, distribute The end result on the health-related institution, and Exhibit it about the terminal in the healthcare establishment by an input / output monitor as proven in FIG. As a result of the perseverance, When the written content from the inquiry would not conform for the enter information and designated ailments from the evaluation and payment establishment and also the insurance company, a pharmaceutical team enjoyable these is searched and identified and distributed towards the professional medical institution.
Because of this, although keeping the fairness of getting health care providers, the insured / insurer / assessment / payment institution has the opportunity to find a drug that may be considered fascinating in the viewpoint of effectiveness, price tag, and so forth. Just isn't provided plenty of. As a result, the challenge on the present invention would be that the insured individual / insurance company or assessment / payment institution wishes to prescribe the strongest prescription among alternate options while preserving the fairness of obtaining medical providers in Japan's clinical insurance program.
Need to your health-related medical doctor requirements the pharmacist to provide you with a particular brand of medication, they've to exactly Notice this or register the Place sent.
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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。
At the moment, an information method that replaces the creation and application of the above-mentioned receipt using an electronic strategy from a standard published system has now been set into sensible use. However, in The us, Pharmacy Benefit Administration (“PBM”) is a company that manages dispensing charges for policyholders.
In the standard payment assessment strategy, a health care institution challenges a prescription and prescribes and pays to the drug for the patient at an insurance plan pharmacy, and so forth., then the examination ask for to the healthcare observe is created towards the assessment payment institution. Having said that, it truly is impossible to judge the suitability of the applying contents in advance for clinical establishments. Furthermore, the insured / insurance provider (health insurance policy Affiliation, and many others.) that bears the cost of pharmaceuticals will not be fully informed about information on drugs for example efficacy and cost, which is absolutely informed regarding the existence of a number of possibilities. It is commonly not carried out. For this reason, the selection of medicines is solely remaining towards the judgment of a healthcare institution, and it is difficult to physical exercise the correct to decide on medicines as a cost bearer and a consumer.
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、判定の結果、照会内容が審査支払機関及び保険者の入力情報や指定条件に適合しない場合には、これらを満たす医薬品群を検索・同定し、医療機関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。
Up coming, the movement by which the indicates in the present creation is executed might be explained in time collection with reference to FIG.
・ It is far from intended to broaden the options for pharmaceuticals of insurers and lower the price of prescribed drugs. Moreover, PBM in The usa gives drug cost administration expert services for corporations for instance businesses as the main customers and isn't going to cover all citizens. just isn't.