Alipay as the representative of the third party payment platform from the application to the medical services industry since 2014, the rapid pace of development, which has certain significance in improving patients queuing time, payment time is long, long waiting registration etc.. Third party payment application in public hospitals has been limited to the expense of patients, Medicare patients by the test of social security card real-time decomposition settlement restrictions, can not use the third party payment. At present, some areas of medical insurance departments through the payment platform in cooperation with third parties, the establishment of virtual Medicare card collection of patient information, try Medicare real-time settlement decomposition of mobile online payment, in the maintenance of health insurance fund safety, promote the patients with medical insurance medical treatment, real name simplified hospital process has made some achievements.
Alipay as the representative of the third party payment platform, with its convenient to break the geographical restrictions advantage, quickly accepted by the public. Medical service industry to adapt to the development trend of the industry, but also gradually apply the third party payment platform, in particular, a variety of mobile registration, diagnosis and treatment of APP and payment methods came into being.
In June 2015, the State Council approved the Internet industry guidance , the implementation and development of Internet penetration in various industries, the national health service system planning outline (2015-2020) pointed out that the positive development of online appointment registration, consulting, communication and other health services; the gradual expansion of digital medical treatment to explore the development of portable health equipment, data acquisition equipment, integration and networking, mobile Internet, improve automation, intelligent health information services. In May 2014, Alipay as the representative of the third party payment companies have started to carry out the third party payment service in medical institutions. Third party payment to facilitate its payment, without the time and place to limit the advantages of rapid recognition of patients. But for patients with health insurance, the impact of social security card real-time settlement of the settlement, has been a bottleneck in the application of third party payment. Recently, through the cooperation of some areas of medical insurance management department and the third party payment companies, open up the channel to break down the payment of medical insurance, in the third party payment insurance mode has been tried.
Application of third party payment in public hospitals
According to incomplete statistics, the country has implemented third party payment platform for more than three public hospitals have more than 700, nearly a thousand public hospitals at all levels. According to the Planning Commission released by the end of September 2015 the national public hospital a total of 13304 calculations, the third party payment platform application ratio is about 7.5%, but accounted for a relatively small, geographically, covering 90% provinces, the provinces have carried out the main city. From the service amount, as of September 2016, the third party payment has been implemented for 2 years in the public hospitals, with total service amount to about 5000 times more than that of public hospital human cumulative savings of 8400 working days, the cumulative savings were 18326 hours, greatly shorten the waiting time for medical treatment, to provide a convenient service to the patient. The first batch of third party payment services to carry out medical institutions trading up to 5000-6000 pen, which accounts for about 60% of registered payment. The third party payment platform in medical institutions for medical treatment has greatly eased the three long and one short (queue time, long waiting time to see a doctor, take medicine doctor, long queuing time short time) problems, especially in reducing the queuing time registration has obvious significance. Through the third party payment of registration and consultation between the mobile payment mode, replacing the queuing process, the average treatment time were shortened to 0.5-1 hours. The total treatment time by window treatment, such as the payment queue up, the average time-consuming 120 minutes to 48 minutes, greatly improve the patient’s satisfaction (medical experience), and improving the hospital’s medical environment.
Third party payment medical insurance model
The relationship between medical insurance account and third party payment account
Third party payment platform and the social security system through the establishment of data interface, you can collect the basic information of patients with medical insurance. With payment platform or APP registered virtual health insurance card in the third party by ID number and social security number, and medical insurance center information database of personal information in the identity and Treatment Association, and the real name to bind bank account, trading through the third party platform in medical treatment – identity – payment and other links between. The third party to pay medical insurance account binding requires Medicare patients must be registered on the third party payment platform has a real name certified debit card or credit card information. For patients with health insurance certification through the health insurance system and personal credit system jointly completed.
Medicare settlement process
Medicare patients with binding information, the medical center and the third party platform double identification verification, virtual social security card successfully established. In the public hospital registration information through the third party platform transferred to the medical center information database, according to the medical insurance center enjoy health insurance benefits, and will pay the cost for real-time decomposition of data returned to the third party platform, in the third party platform to complete the required part of the burden of payment. This process relies on the implementation of the third party payment platform for large data processing and information security capabilities, able to complete various data analysis and calculation in a very short period of time, to ensure the patient cost real-time decomposition.
Identification and authentication of medical insurance patients
The third party payment platform has advantages in patients with identity authentication, identity information can be through the national public security network, bank information system and the medical insurance information platform and multiple electronic photo identification, change the original status of the doctor only through social security card eye photograph than verification of identity, authenticity and uniqueness of identity recognition were more careful. At the same time in the transaction process, dynamic password refresh, virtual social security card input Alipay password step, prevent fraud false social security card, is of great help to the strict real name seeking behavior. After the correlation of the real medical information, the excessive medical treatment, irrational drug use, high prescription and other acts have also been monitored, which can promote the rational management of hospital treatment.
Health insurance fund security measures
From the patient’s perspective, a social security card and a Alipay account bound, for the replacement of the original account to account unbundling. In Medicare payment, the third party payment platform will verify the transaction channel and the user ID information in the medicare information platform for the record is consistent, inconsistent refused to trade. From the fund level, the medical insurance fund to pay part of the third party payment platform to collect transaction information flow, do not go to the flow of funds, so does not affect the existing medical insurance settlement policies and rules.
Medicare patients in the diagnosis and treatment of the detailed data of hospital is not through the third party payment platform, the hospital medical information or through the original channel uploaded to the health center, health care center to return to the hospital settlement No. ID from the ID hospital, pass to third party payment platform for insurance settlement on the line. From a security perspective, as a result of the third party payment platform authentication error bound card error, or the third party payment account by others fraudulent settlement of medical expenses, resulting in the user’s personal and fund losses, the third party payment platform full payment.
The practice of third party payment medical insurance
The transaction is not timely refund back number
The research found that despite the development of a professional reconciliation tool, but for WeChat Alipay has registered time and timely does not solve the problem of payment service in return, refund. The small single amount, large amount, difficult to ensure real-time reconciliation; especially relates to health care for decomposition, logical relationship between various reconciliation statements is more complex, flawed tables and relations, has not yet been fully resolved. Part of the medical insurance refund back long treatment time, influence patient satisfaction, and increase the toll and the cashier cash management risk.
Only bind their health insurance accounts
An account of the third party payment can only bind their own health insurance card, and the payment of the account must be bound to the bank debit card or credit card, the purpose is to ensure the accuracy of the identification of the third party. Survey of elderly patients generally reflect the low degree of acceptance of new things, bound by a debit card or credit card has some difficulties, I hope to be able to account for their children or relatives related to social security accounts. At present, such needs can not be achieved, still need to improve the social security card identity information collection and the establishment of a unified platform.
Public hospitals have no unified process
Public hospitals for the third party payment is not a unified process, Medicare patients using different payment processes are different from the third party platform, to bring some inconvenience to medical treatment and payment. For a refund, refund, the process is not standardized.
Relying on social security card information platform
The Department in November 8, 2016 issued the Internet network service 2020 action plan , the theme of which is the establishment of payment and settlement , clearly pointed out that the content of payment and settlement should accelerate social security card financial function, wide by third party cooperative commercial bank, payment platform and other channels, the expansion of the online payment mode.
Third party payment insurance model of the promotion and identity authentication accuracy may be relying on the future of China domestic employment or participate in the social insurance Chinese citizens, foreigners, Hong Kong and Macao personnel social security card in 2020 covering 90% of the population and popularity, to build a unified national identity authentication platform construction the national unified credit information platform, improve information sharing and checking mechanism and the uniqueness of the identity to complete. The improvement of the social security account information will provide the guarantee for the wide application of third party payment and information security.
Unified HIS interface specification
One of the technical difficulties in the implementation of third party payment in public hospitals is the diversity and level of HIS in public hospitals. For the popularization and application of a large area has brought another bottleneck. To this end, the hospital needs to further improve the standardization of HIS system, in line with the technical requirements of the third party payment. At the same time, it lays the foundation for further data management, analysis and application of big data.
Consider multi benefit and demand
Ensure information and transaction security
We can not ignore the security of information security only for the convenience of patients. For patients with health insurance information, hospital information and medical insurance settlement information security should be put in the first place to study and solve. With the success of the third party payment platform experience, combined with their own characteristics.
Standard process and emergency measures
At present, the third party payment in terms of medical care is less standardized, public hospitals for Medicare patients to pay the application of the third party is more in the water test stage. Application of process specification should be introduced to the third party payment, at the same time for processing special problems such as withdrawal of deposits should also be provided. For patients with information security, medical information security, transaction information security emergency measures need to be complete.
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