医保数字化转型探究——以浙江省智慧医保为例
Research on Digital Transformation of Medical Insurance—Taking Zhejiang Smart Medical Insurance as an Example

近年来，党中央高度重视新一代信息技术在医药卫生领域的应用。杭州市医保局把握新时代医保信息化发展要求，在2022年2月15日正式上线智慧医保系统。基于杭州成为信息化优势城市的考虑，本研究以杭州市智慧医保发展现状及居民满意度为调查主题，采用实地调查、问卷调查等方式对杭州市各定点医药机构的智慧医保发展现状及居民使用情况进行调查，探究杭州市居民对于智慧医保的满意度，进而总结智慧医保建设成效及不足之处，为其进一步完善升级提供参考。最终得出以下结论：1) 居民注重智慧医保的线下场景体验，对于基础医保业务需求较大。2) 医保电子凭证能满足居民的就医买药需求，其推广得到支持，但老年群体尚未形成优先使用习惯，数字鸿沟问题仍待解决。3) 智慧医保的操作情况会影响居民的使用行为，推广过程中要注重解决居民的实际操作问题。4) 智慧医保的负面评价会反向作用于服务评价，居民对智慧医保的信息安全问题仍存有顾虑，需加强智慧医保的安全性。
Recently, the CPC Central Committee has attached great importance to the application of new-generation information technology in the field of medicine and health. Hangzhou Medical Insurance Bureau grasped the development requirements of medical insurance informatization in the new era, and officially launched the smart medical insurance system on February 15, 2022. Based on the consideration of Hangzhou becoming an information-based advantageous city, this study takes the development status of smart medical insurance in Hangzhou and residents’ satisfaction as the survey theme. Field survey and questionnaire survey are adopted to investigate the development status of smart medical insurance in designated medical institutions in Hangzhou and the use by residents, so as to explore the satisfaction of Hangzhou residents with smart medical insurance, then summarize the effectiveness and shortcomings of the construction of smart medical insurance, and provide reference for its further improvement and upgrading. Finally, the following conclusions are drawn: 1) Residents pay attention to the offline scene experience of smart medical insurance, and have a large demand for basic medical insurance business. 2) Medical insurance electronic certificates can meet the needs of residents for medical treatment and medicine purchase, and its promotion has been supported, but the elderly group has not formed a habit of priority use, and the problem of the digital divide still needs to be solved. 3) The operation of smart medical insurance will affect the use behavior of residents, and attention should be paid to solving the practical operation problems of residents in the promotion process. 4) The negative evaluation of smart medical insurance will negatively affect the service evaluation, and residents still have concerns about the information security of smart medical insurance, so it is necessary to strengthen the security of smart medical insurance.