宁波市大病医等疗保险平台建设方案.doc

《宁波市大病医等疗保险平台建设方案.doc》由会员分享，可在线阅读，更多相关《宁波市大病医等疗保险平台建设方案.doc（87页珍藏版）》请在三一办公上搜索。

1、First compliance review of the application of the appraisal Committee, only through the compliance review of the application to take part in a detailed review. 8.1 application compliance review: does not meet one of the following conditions, procuratorial Agency to submit application through complia

2、nce reviews, be invalidated: (1) application of the formats, contents, meet the requirements of selected files, powers of Attorney, declarations by the legal representative and the tender agent application to meet the requirements; (2) licence and a bidding agent qualifications meet the requirements

3、; (3) the similar project tendering agency agent number and provide proof of material compliance; (4) the tendering Agency intends to put into this project the number of professionals to meet the requirements; (5) are intended to the agent of the project as a project manager has similar projects the

4、 number of and references to meet the requirements; (6) no fraud case. 8.2 application review in detail the Evaluation Committee through compliance reviews will be selected for detailed review of the application. 8.2.1 tender agent institutions similar project tender performance requirements (16 poi

5、nts) tender agent institutions similar project tender performance 16 points, by two part composition (1) agent similar project of cumulative bid amount scored calculation rules for: Agent water project bid amount (on January 1, 2007 has has bid notice for associate) cumulative each reached 100 milli

6、on Yuan have 2 points, water project cumulative bid amount scored up not over 6 points. In addition, completes a bid worth more than 500 million yuan in total 1 minute, but other items score accumulated winning amount up to a maximum of 6 points. (2) calculation rule for the number of agents similar

7、 projects: proxy bid amount (since January 1, 2007 winning notice shall prevail) bidding projects in more than 50 million Yuan by 2 points, but the Agency projects the number of scores up to 3 minutes. 8.2.2 to be agents of the construction project as a project manager in the same project performanc

8、e (10 points) Project Manager agent performance scores including agents of the bidding agencies of similar projects, as well as in other similar project tendering agency service agent during performance. Total 10 Project Manager agent performance, made up of two parts (1) acting like the accumulated

9、 winning amount calculation rule: agents for water conservancy project bid amount (since January 1, 2007 winning notice for example) cumulative average reached 100 million Yuan 3 but scored no more than 5 minutes. (2) calculation rule for the number of agents similar projects: proxy bid amount (sinc

10、e January 1, 2007 winning notice for example) in the more than 50 million Yuan water conservancy project period of 3 minutes, but scores the number of agents similar projects up to a maximum of 5 points. Project Manager demonstrated to provincial-level and higher peoples Government or the developmen

11、t and Reform Commission published the winning bidder on the designated media publicity shall prevail. 8.2.3 staff requirement (25 points) 1, to the construction project serving personnel, 4 years experience in tendering agent, 2 points per person, 2 years experience in tendering agent .Pig is not a

12、pig. With domestic international market and technology big environment of changes, as China traditional industry of pig production of job way and profit way are requirements related industry for resources integration, to quality security for premise, regulation based farming, and management cost and

13、 the production, and sales cost, go standardization, and scale, and intensive, and market road, fast upgrade whole industry chain of regulation capacity, market competition capacity and anti-risk capacity. First, industry analysis (a) the basic situation in China is a traditional hog production and

14、consumption country, 2008 46.15 million tons of pork, pig stock 462.64 million head by the end pig slaughter 609.6 million. National pig industrys annual production value at around 650 billion yuan, nearly 50% per cent of annual output value of animal husbandry. Sichuan province in 2008 produced 6.5

15、2 million tons of pork, with 694,000 tons of Chengdu city, live pig sell 10.46 million, first 15 Vice-provincial cities in the country. The whole nation advantage regional planning (2008-2015) there are 437 counties (cities), 55, Sichuan, Chengdu has 7 (including in pengzhou). International pig indu

16、stry mainly include the European Union, the United States, and Canada, and Brazil and other absolute scale of animal husbandry industry and technology developed countries. Market 1, the domestic market from Chinas meat consumption habits and economic analysis of the development situation, the emerge

17、nce of new trends in the market of domestic pork and its products. Docking is a pig production and sales more closely. The Yangtze River Delta, Pearl River Delta and the Bohai rim economic developed area industrial structure adjustment gathered pace, two or three industries to the Central and Wester

18、n bias. Second, the rigid domestic consumption growth. For a long period, pork is still the largest variety of meat consumption in China, the absolute consumption continues to grow. Especially in the vast rural market growth potential. Third, market for pork and higher product quality requirements.

19、Pollution-free pork safety and health has shown a very good market prospects. Four is the market changing. Currently, cold meat, more and more varieties of meat and pork meat products, which accounted for a large proportion of pork consumption, stores, chain stores, supermarkets and other marketing

20、methods is on the rise, and transport has been extended to more than 2000 km in RADIUS. Chengdu is an important River pig resource market, the citys commercial rate reaches above 60% of live pigs, pork and raw materials primary processing products in the domestic and international reputation is high

21、. Western hog trading center in Chengdu and provides disease-free areas of construction in order to further accelerate the development of swine industry realizes space and conditions. 2, the international markets at present, annual volume of trade in live pigs in the world year around 18 million, ab

22、out 6 million tons of pork trade. A large net exporter of pork is mainly the EU and North America,-importing countries mainly in Asia, Japan, and Korea, and Singapore, the Philippines, Hong Kong and other countries and regions, as well as Russia, about 3 million tonnes were imported. It is predicted

23、 that the world meat consumption increase of 80% in Asia in the future, our country has obvious geographical advantages, export potential. With the advancement of live pigs superiority industry belt construction, animal disease . 宁波市大病保险接入平台建设方案宁波市大病保险接入平台项目建设方案2014年3月目 录第1章 总体情况11.1 建设背景11.2 指导思想21

24、.3 建设目标31.4 设计原则31.5 项目意义4第2章 总体设计62.1 总体设计思路62.2 总体技术路线62.3 系统设计方法72.4 总体架构设计82.5 系统交易流程设计102.6 系统分层模型设计112.6.1 基础设施层112.6.2 基础应用层112.6.3 应用支撑层122.6.4 业务逻辑层122.6.5 交互表示层122.7 系统数据架构设计122.7.1 数据架构设计的标准和原则122.7.2 性能优化策略142.7.3 数据库建设思路142.7.4 存储安全规划152.7.5 数据分布策略162.7.6 数据质量控制18第3章 建设内容223.1 全市大病保险接入平

25、台223.1.1 社保或新农合数据共享接入系统223.1.2 大病保险数据传输系统223.1.3 市级综合数据分析平台223.1.4 清算系统开发233.2 大病保险平台布置与调试233.2.1 模拟调试环境243.3 医疗保险经办机构实施联调测试243.3.1 医疗保险经办机构数据共享接入调试253.3.2 医疗保险经办机构数据共享接口验收测试253.4 整体联调实施253.4.1 数据交互整体联调实施263.4.2 应急管理子系统38第4章 保障措施394.1 质量管理原则394.2 质量保证与质量控制404.3 开发测试流程414.4 客户化测试流程434.5 项目开发规范444.6 版

26、本控制454.6.1 版本开发管理流程（PDF）454.6.2 版本关键过程控制464.7 项目进度安排524.7.1 项目进度计划524.7.2 项目阶段划分53第5章 技术服务、技术培训、售后服务的内容和措施565.1 技术服务内容和措施565.1.1 完工期565.1.2 售后服务565.1.3 人员培训575.2 技术培训内容与措施575.2.1 培训对象与内容575.2.2 培训方式585.2.3 培训计划585.2.4 培训课程安排595.2.5 培训质量保障605.2.6 培训流程615.3 售后服务内容与措施625.3.1 售后服务承诺625.3.2 售后服务体系635.3.3

27、 售后服务方式655.3.4 服务流程与规范665.3.5 售后服务保障734.1 application of the Chinese language application for proxy bidding agency application system. 4.2 bidding agent applications should be submitted by the Agency included in the 5th chapter of the content, and than select file asked to provide appropriate docume

28、ntation. 4.3 proxy application shall affix its official seal coding and page by page in the specified location. Agent a copy of the application shall have to number the pages and signed original copy (copy) (including supporting documents), and copy should be exactly the same. 4.4 application there

29、shall be no loose pages. 4.5 agent application should be complete with indelible ink (powdered) prints, the agent shall not alter any page of the application. 4.6 bidding agencies offer should be based on the interim measures for the management of tendering agents service charges (meter prices 20021

30、980) rules of the Nineth, tender agent service charges using the difference progressive billing rate. Charges in accordance with the tendering agents service charges and, in conjunction with the provisions of the specific circumstances of the project shall not be floating up and down-floating range

31、must not exceed 20%, otherwise the application cannot pass compliance checks, be invalidated. Due to bidding agency selection and principal-agent contracts signed during charging base bid amount has not yet been produced, it can only be according to the rates of price, bid and the bid amount determi

32、nes after the end, controlled response rates calculated shall pay tender fee (tender agency fee accounts for the actual bidding agent item for fares). Than the selected person tendering agents service charge control the upper and lower limits, Cap for the State Development Planning Commission of the

33、 interim measures for the management of tendering agents service charges (meter prices 20021980) of tendering agents service fees under 100%, the lower limit for the State Development Planning Commission of the interim measures for the management of tendering agents service charges (meter prices 200

34、21980) of tendering agents service fees under 80%. Tendering agents service charge base should include the following tenders: construction, supervision and material over the above tenders are expected to be important, with each tendering agency entrusted with tender bid amount as a base for a separa

35、te computation of tendering agents service fees. Tendering agents service fee payment in accordance with the General Office of the State development and Reform Commission on tendering agents service charge of notification on the relevant issues (the change price 2003857). Sale of prequalification do

36、cuments and solicitation documents going to choose all, pricing should be based on the principle of profit not files, must not violate the relevant provisions in the price Department. 4.7 requirements in the form of application proxy application shall be prepared in the 5th chapter of the format. Ap

37、plication of various supporting documents should be requested by the selection of files grouped by order. Comparison and selection of the bidding agencies must provide supporting documents required by the file; the file you selected does not have the required supporting documents, bidding agency ack

38、nowledged the need to provide, or you can provide. Proxy application shall be bound, and page-by-page coded in the order. 5th chapter application format notes: bidding agent . - 81 -第1章 总体情况1.1 建设背景 近年来,随着全民医保体系的初步建立,人民群众看病就医有了基本保障,但由于我国的基本医疗保障制度,特别是城镇居民基本医疗保险(以下简称城镇居民医保)、新型农村合作医疗(以下简称新农合)的保障水平还比较低,

39、人民群众对大病医疗费用负担重反映仍较强烈。 城乡居民大病保险,是在基本医疗保障的基础上,对大病患者发生的高额医疗费用给予进一步保障的一项制度性安排,可进一步放大保障效用,是基本医疗保障制度的拓展和延伸,是对基本医疗保障的有益补充。开展这项工作，是减轻人民群众大病医疗费用负担,解决因病致贫、因病返贫问题的迫切需要;是建立健全多层次医疗保障体系,推进全民医保制度建设的内在要求;是推动医保、医疗、医药互联互动,并促进政府主导与市场机制作用相结合,提高基本医疗保障水平和质量的有效途径;是进一步体现互助共济,促进社会公平正义的重要举措。 在关于开展城乡居民大病保险工作的指导意见（发改社会20122605

40、号）中提出“依托商业保险机构的专业优势,支持商业保险机构承办大病保险,发挥市场机制作用,提高大病保险的运行效率、服务水平和质量”。根据发改社会20122605号规定，经有关方面协商，决定在2014年上半年起通过招标方式委托商业保险机构承接宁波全大市各县市区城镇职工和城乡居民人员的大病救助保险。而本宁波市大病保险接入平台项目建设总体目标，就是以信息技术为支撑、以城镇职工医保和新型农村合作医疗为依托，先垫付后清算，采用统一的数据采集标准，融合多种交互方式，建成适用于宁波本地实际的大病保险平台，有效解决宁波市大病保险报销不便，数据共享难等问题。系统整体设计按照平台交换模式进行系统建设，要求将算法嵌入

41、各地医保或新农合的实时报销算法中，实现大病保险实时结算。事后再通过大病保险接入平台进行数据共享的方式，由经办机构与商业保险公司清算。 围绕大病保险接入平台建设，以科学发展观为指导，以系统稳定运行为宗旨，对宁波市大病保险接入平台进行实时监控为目标，加强对信息系统全面的应用综合管理，按照“整体规划，分步实施；集中管理，分级建设；逐步推进，急用为先”的工作思路，实现宁波市大病保险接入平台稳定安全运行。1.2 指导思想1、“统一规划，分级建设”大病保险接入管理平台依照“统一规划，分级建设”的原则，市保险协会建设全市统一的大病保险接入管理平台和专网，提出统一的接口规范和技术路线，各地社保或新农合管理机构

42、负责当地系统改造和网络接入。2、“标准一致，多种兼容” 由大病保险平台制定统一的医疗保险经办机构数据共享标准，各家保险公司采集的数据统一按照平台提供的数据标准，但是允许各家保险公司使用不同的接口规范，平台兼容各家保险公司的webservice服务。3、“实时结算，异步共享” 根据发改社会20122605号文件精神，要求参保人在医院刷卡就医报销时能够通过一次性结算享受包含大病救助费用在内的医疗待遇。经办机构在实时结算系统中内置大病救助算法，实时结算过程中不与保险公司相关系统进行信息交换。经办机构通过设置预警线的方式，按天将费用达到预警线的信息告知大病保险平台，各家保险公司可通过大病保险平台查询相

43、关信息。4、“统一平台，多种交换” 通过建立统一的信息接入平台实现与不同机构之间的对接。既满足与各个社保系统、新农合系统之间通过SOCKET方式对接，又满足于各个商业保险公司之间通过WEBSERVICE方式对接。5、“统一支付，两点清算” 为实现参保人能够实时联网结算大病保险救助，要求定点医疗机构先进行统一垫付大病保险救助金。各个社保系统、新农合系统与定点医疗机构进行结算。保险公司先支付各个社保系统、新农合系统履约保证金，事后每月通过各个社保系统、新农合系统与各对应的商业保险公司之间进行数据核对和清算已发生的大病保险业务。6、“分区管理、标准各异” 目前由于各区社保系统、新农合系统的医疗基础信

44、息可能存在标准不统一的情况，比如三大目录，可提供的费用明细范围、信息项目等，这就要求平台以及各商业保险公司支持医疗基础信息分区管理，分区进行个性化处理；而各区社保系统、新农合系统也需要自行管理自身的医疗基础信息，并在医疗基础信息发送变化时及时告知平台。1.3 建设目标为保障相关工作顺利推行，解决技术障碍，降低总体成本，提高项目质量，宁波市保险业协会组织各家商业保险公司商讨，共建一套“宁波市保险业大病救助接入平台”(以下简称大病保险平台)。大病保险平台将采用统一技术标准和接口支持全大市城镇职工、城乡居民和新型农村合作医疗保险人员的大病信息导入和分区域数据管理，支持各商业保险公司获取相应权限的数据

45、，实现大病救助保险信息查询统计。工作计划上力争在2014年上半年建成“宁波市保险业大病救助接入平台”，实现试点医疗保险机构和试点商业保险公司的数据对接和共享，完成包含数据初始化、日常数据交换、大病费用清算和对账的完整业务周期，支持各接入系统间数据和交换信息查询和统计。在下半年在全市进行推广，实现宁波大市范围内的大病保险平台建设。1.4 设计原则根据保险行业和医疗保险经办机构对大病保险平台的总体要求和部署，坚持可行性、前瞻性和可操作性原则，结合宁波市实际情况，设计中应该遵循的具体原则如下：（1）标准性和规范性 大病保险平台制定统一的标准数据采集规范，坚持标准化与规范化，也使得各职能部门之间系统信

46、息资源更加易于共享。（2）扩展性和开放性系统构架须具备可扩展性，能够随着应用的逐步完善和用户的逐渐增加不断地进行扩展，为今后二次开发预留基础。同时，系统具有很好的开放性，能支持各种相应的软硬件接口，具备与多种相关系统互连互通的能力，真正在结构上实现开放。（3）先进性与成熟性系统设计立足采用先进的计算机技术和先进的解决方案，尽量采用成熟的主流产品，集成优秀和成熟的技术及组件，以保证系统的高质量和高稳定性，使项目具备国内先进水平。（4）可靠性和安全性在进行系统设计时，应采用多种安全技术手段加以保证，从系统性能指标要求、系统安全体系建设、与其他系统之间的接口关联、系统的恢复与容错、系统的互备切换等各

47、方面都提出切实可行的方案，对相关的主机系统、应用数据库提供严密的保护，防止系统的数据被非法获取或破坏。（5）易用性和可维护性按照标准和规范的方法进行系统组件化设计，系统数据维护方便，备份及数据恢复快速简单。（5）整体规划，分步实施确保异地就医业务应用正常开展。规划本地运维实时监控和日常管理，分步实现网络、主机系统、业务应用、平台软件等集中监控管理。（6）健全制度，落实责任制定应用系统业务监控管理制度，加强日常管理，做好本地监控系统和基础设施建设，确保全市业务监控管理系统的实施和运行，实现与支持统一综合运维管理系统的对接。1.5 项目意义目前，宁波市内大病保险支付还处于人工报销状态。参保人员在医

48、疗结算之后还需要拿着发票到对应的保险公司进行手工大病保险赔付，对参保人造成了诸多麻烦。而对于保险公司的业务人员，还需要对各就诊明细重新录入系统，造成了重复劳动。结合以上方面，就需要建立一套相应的机制，已满足大病保险实时赔付，并将赔付信息和医疗明细信息共享至保险公司的需求。通过对本次宁波市大病保险平台项目软件和集成项目完成，可以有效的满足参保人对于大病保险实时赔付和保险进行相关数据采集的现实需求，通过信息化手段实现各个机构之间的数据共享，简化了赔付流程，避免重复劳动，有效提高了大病保险业务的开展效率。另外，统一平台的建立便于确保社会基本医保、新农合核心业务系统的数据安全；便于提高保险公司大病医保业务系统的对接速度；便于整合行业资源，为今后的系统调整奠定基础；便于实行行业监管，提高大病医保操作的规范性。第2章 总体设计2.1 总体设计思路根据本项目建设原则和总体目标要求，我们提出以下总体设计思路： 1、“统一采集，多种交互” 发布统一数据采集接口、统一目录和各类代码，各区