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。
【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。
Investigate has tested that the percentage of patients with multiple medications is expanding. So has the necessity for varied caregivers and/or Qualified health-related assist personnel in your supplied unique.
Come to be. Due to this fact, as an example, the examination / payment company raises the prescription priority order of more practical medicines so a large number of health-related institutions can prescribe the medicines. Consequently, the standard of professional medical expert services as well as the fairness of prices amid insured folks Promoted. Furthermore, a rise in prescription of the cheapest drug amid a plurality of drugs owning exactly the same result can even be received, such as reduction in drug expenses for insurers and insured individuals.
Next, the flow in which the means of the present creation is executed might be described in time collection with reference to FIG.
Every time a prescription advised drugs is selected by a healthcare establishment, the handling status / stock position at a nearby insurance policies pharmacy is verified and The end result is notified.
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Cautions Inform: U.S. Boxed Warning - The FDA-permitted labeling includes a boxed warning. See Warnings/Precautions area for the concise summary of this information. For verbatim wording on the boxed warning, consult with the products labeling or . Warnings/Safeguards - Precautionary considerations, hazardous circumstances associated with use from the drug, and illness states or patient populations by which the drug ought to be cautiously used. Boxed warnings, when current, are clearly discovered and so are adapted within the FDA-permitted labeling. Check with the item labeling for the exact black box warning with the maker's or the FDA websites. Monitoring Parameters - Laboratory tests and patient Bodily parameters that needs to be monitored for safety and efficacy of drug therapy Pregnancy Threat Variable - Five groups founded with the FDA to point the opportunity of a systemically absorbed drug for triggering risk for the fetus Pregnancy Considerations - A summary of human and/or animal information pertinent to or associated with the use of the drug because it relates to clinical effects about the fetus, new child, or Expecting girl Lactation - Implies if the drug detailed from the monograph is present in breast milk along with the maker's advice to be used even though breast-feeding (when suggestion of yankee Academy of Pediatrics differs, notation is manufactured) Patient Education - Particular ADHD medication information information pertinent for your patient
From the prescription information inquiry / distribution system In accordance with declare 1, once the prescription medicine inquired through the medical establishment for every professional medical observe satisfies the selected conditions with the insurance company / evaluation / payment institution, the address of the medical establishment or insured man or woman Drug prescription information inquiry / distribution method that accesses and confirms the handling information / stock information on the drug at many insurance policies pharmacies near the pharmacy.
And when you get an inquiry about medical prescriptions from the health care institution for every specific health-related practice, insured human being information (health care insurance policies associated information, information on sickness / indications, and so forth.
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An example of the configuration of these types of an information process is proven in FIG. In this instance of information technique, at the very least display and output device / enter unit / details storage for example normal notebook computer with communication usually means set up in Each individual of assessment spending institution, insurer, coverage clinical institution, insurance pharmacy In addition to a central process that performs information inquiry / willpower are related through a interaction line for instance the net.
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。