A medical treatment insurance fund payment device and method

Abstract

The invention relates to a device and a method for medical insurance fund payment; which at least comprises an initialization device, a medical information collection device and an insurance clearing device and is characterized in that it obtains initial parameters and an information security transmission channel through system initiation, collects medical treatment and fees information of designated institutions and the market price of medicine, medical facilities and materials and so on, then estimates the cost of operation and loss according to the categories, checks the revenue of a category according to medical quality standards and estimates the actual rate of return according to the total cost of the category, regulates the initial cost through comparing the actual rate of return with the fixed rate of return so as to cause the new price to match with the fixed rate of return, estimates the initial fixed amount with different types of disease and the states of the patients in hospital according to the new cost, then modifies the initial fixed amount through modifying the weighting to obtain the next new fixed amount, and clears insurance between an insurer and each operator and insurers according to the current price and the fixed amount.

Description

technical field [0001] The present invention relates to a computer system, more particularly to a device and method for payment of medical insurance benefits. Background technique [0002] Obtaining an insurance card by participating in medical insurance, using the insurance card to obtain and pay for medical services covered by medical insurance through medical insurance designated institutions is an important business of medical insurance today, and the insured can obtain appointment from any medical institution designated by the insurer Medical services within the specified range and the purchase of specified range of drugs at any drug store within the specified range, while medical services and drugs beyond the specified range of the insurer are not allowed; a typical situation is that the doctor of the medical institution Diagnose the disease, or issue a laboratory test sheet, and issue a prescription after the result comes out, and the insured person will receive the m...

AI Technical Summary

Problems solved by technology

[0014] First, due to the imperfection of drug procurement rules and the complexity of the medical process, policyholders and insurers do not have the conditions and means to implement supervision;

[0015] Second, the pricing mechanism of medical institutions does not match their actual costs; medical institutions have to rely on income from medicines and testing to cover their operating costs, resulting in the phenomenon of expensive medical treatment, which has become a common problem in our society and even in the international community;

[0016] Third, China's current social insurance is based on cities and counties as independent financing and accounting units. Due to the inconsistent payment methods and standards, it is difficult to settle settlements in different places. , causing a lot of trouble for the policyholder to live in different places;

[0017] Fourth, the starting point and scientific nature of the disease diagnosis payment plan cannot be questioned, but the calculation of its prepayment quota is based on the medical record data of the past three years. Under the current situation that the medical price in our country has been distorted, the calculated quota It is also inconsistent with the actual cost, and cannot be combined with the control of outpatient medical expenses; at the same time, the current social insurance in my country is based on the city and county as the overall planning unit, and it is very difficult for each insurer to establish and operate this system separately. Adjusting and perfecting this system is a long-term work, and the cost is extremely high

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