An abnormal hospitalization behavior judgment method and a related product

Abstract

The invention discloses an abnormal hospitalization behavior judgment method and a related product, the method is applied to electronic equipment, and the method comprises the following steps: obtaining historical hospitalization data of an insured person from a medical database of any medical institution; extracting various expenses in the historical hospitalization data, wherein the various expenses comprise medical expenses, surgical expenses, postoperative reexamination expenses, preoperative examination expenses and total hospitalization expenses; respectively calculating the proportionsof the medical cost, the surgical cost, the postoperative reexamination cost, the preoperative examination cost and the total hospitalization cost; and determining a determination result for the hospitalization behavior of the insured person according to the ratio of the preoperative examination cost to the total hospitalization cost, the ratio of the medical cost to the total hospitalization cost, the ratio of the surgical cost to the total hospitalization cost, and the relation of the ratio of the postoperative reexamination cost to the total hospitalization cost. According to the embodimentof the invention, the probability of extracting the medical insurance fund is reduced.

Description

technical field [0001] The application relates to the field of medical technology, in particular to a method for judging abnormal hospitalization behavior and related products. Background technique [0002] With the continuous strengthening of the national basic medical insurance system, more and more people join the ranks of medical insurance. When the insured person sees a doctor, the Medical Insurance Coordination Foundation reimburses most of the medical expenses for the insured person. However, the current medical insurance system is still not perfect. As a result, there are many interest issues in the reimbursement process. In many cities, medical examination items are not included in the reimbursement category of the medical insurance pooling fund, and the medical examination expenses of insured persons can only be reimbursed individually. However, for the insured, as long as the hospitalization expenses meet the deductible line and other conditions, they can use the...

AI Technical Summary

Problems solved by technology

[0003] Therefore, the method of confirming whether the insured person is eligible for hospitalization is single and the accuracy is low, and there is an act of arbitrarily taking the pooling fund to pay for the inspection fee

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