循證評點在醫學核保中的應用The Application of Evidence-Based Rating in Medical Underwriting

摘要
循證醫學是近年在臨床醫學實踐中發展起來的一門新興臨床方法學，其研究的原則和方法日益廣泛應用於臨床醫學研究，使治療方案更科學、更嚴謹，對現代醫學的發展産生了巨大的影響。循證評點是循證醫學的觀點和方法在保險醫學上的應用，循證評點提高了風險評估的科學性和合理性。核保手冊是循證評點的應用實例。隨著醫學證據的日新月異，核保手冊也需要不斷更新。核保手冊的時效性決定了核保人在使用核保手冊進行醫學核保時要遵循證據，與時俱進，不斷更新知識，並自覺運用循證評點的方法，持續提高核保評點的科學性和合理性，這樣才能真正體現核保工作的專業和價值。
關鍵詞：循證醫學、循證評點、保險醫學、醫學核保、核保手冊
Abstract
Evidence-based medicine (EBM) is an emerging clinical methodology evolved from the clinical practice in recent years. As increasingly widely used in clinical research, the principles and methods of EBM make the treatments more scientific and rigorous to the development of modern medicine and generate huge impact on the development of modern medicine. Evidence-based rating (EBR) is the application of viewpoints and methods of EBM on medical insurance, which improves the scientificity and rationality of the risk rating. As an application instance of EBR, the underwriting manual requires constantly updated with the rapid and diverse evolvement of the evidences. Due to the timeliness of the underwriting manual, the underwriter should have the evidences followed when performing the medical underwriting. Meanwhile the underwriter should update the knowledge, apply the methods of EBR self-consciously, improve scientificity and rationality of the risk rating continuously. All that can truly reflect the specialty and value of underwriting.
Keywords: evidence-based medicine, evidence-based rating, insurance medicine, medical underwriting, underwriting manual