Medical insurance payment early warning system and processing method thereof

Abstract

The invention discloses a medical insurance payment early warning system. The system comprises a data collection device (1) which is used for collecting medical file data; the data storage device (2) is used for storing related data of the early warning system; the early warning calculation device (3) is used for calculating the medical archive data and outputting an early warning calculation result, the early warning calculation result is used for indicating whether the medical payment cost corresponding to the medical archive data exceeds an early warning value or not, and the early warning calculation device calculates the medical payment cost by adopting the following calculation formulas: a represents a basic rate, egt corresponding to the medical archive data; 0; b represents a change coefficient corresponding to the medical file data and is greater than or equal to 1; r represents an attenuation coefficient, 0 lt, corresponding to the medical file data; rlt; 1; dCL (xi, A) represents a trunk diagnosis related group A in which the medical file data is located, and xi represents an influence coefficient of other complex diagnoses associated with the trunk diagnosis on the trunk diagnosis related group A. The system is easy to use and powerful in function, and has extremely high commercial value.

Description

technical field [0001] The invention belongs to a computer information processing system, and in particular relates to a processing system used in a medical payment management system, especially a medical insurance payment system or a medical management system matched with a medical insurance payment system, especially a medical insurance payment system used in these systems , and the corresponding medical insurance payment early warning processing method. Background technique [0002] "Diagnosis-related Groups (DRGs)" was born in the United States in the late 1960s. Due to the reform of the payment system of "Medicare" applied in the United States in the 1980s, it has since spread to Europe, Australia and parts of Asia, and has been widely used around the world. Recently, with China's new round of reform of medical payment methods, DRGs, as a more advanced and scientific medical payment calculation method recognized by the world, has been listed as the main pilot direction...

AI Technical Summary

Problems solved by technology

However, these complications cannot be directly used to determine the current complications. There are three main reasons. First, there is no clear literature on the methodology and update methods of these complication models, and there is no way to update and update the models based on current data. optimization

Second, the cost distribution of medical services and the price of diagnosis and treatment services in different countries are not the same, so the impact of complications on costs is not completely consistent

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