Journal of Shandong University (Health Sciences) ›› 2019, Vol. 57 ›› Issue (8): 1-19.doi: 10.6040/j.issn.1671-7554.0.2019.471

• 数据驱动的整合健康保险&健康维护理论方法专刊 •    

Theoretical method system for integrating health insurance and health maintenance in the context of big data

XUE Fuzhong1,2   

  1. 1. Healthcare Big Data Institute of Shandong University, Jinan 250002, Shandong, China;
    2. Department of Biostatistics, School of Public Health, Shandong University, Jinan 250012, Shandong, China
  • Published:2022-09-27

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Abstract: Health insurance are supposed to be united with health maintenance in both theory and practice, while their current combination is not close enough in China. For this reason, this study proposed a novel paradigm that integrates health insurance and health maintenance, and established its big data sharing platform. Then, the theoretical and methodological system for integration of health insurance and health maintenance was established following the design ideas, including big data-driven, cross-system(health insurance and health maintenance)integration, whole-course(life course and disease process)intervention and multidisciplinary intersection. This system includes the theory and method of health management driven by big data, the actuarial theory and method of health insurance, the novel triangular quadrilateral paradigm of I-M-P-G and its management decision-making and policy system. Driven by big data, health management and managed care could be applied in health maintenance, by which decreasing the compensation of health insurance organizations(I), increasing the income and efficiency of preventive/medical service providers(M), maintaining the health of insured population(P)and ensuring the objectives of government(G)were well interacted, and achieved an all-win situation. Meanwhile, this paradigm could give full play to the role of government for macro-regulation to promote the win-win development between social insurance and business insurance, as well as guide the funds to health management and managed care to implement earlier prevention and realize the goals of both reduction of expenditures and maintaining health. This article provided a theoretical method support for the health management system in “Health China” strategy and the new type of operation of “Internet + Health insurance + Health maintenance”.

Key words: Big data, Integration of health insurance and health maintenance, Novel triangular quadrilateral paradigm of I-M-P-G

CLC Number: 

  • R574
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