Control method and device for predicting net pricing cost based on medical insurance treatment settlement sheet

Abstract

The invention provides a control method for predicting the net pricing cost based on medical insurance doctor seeing settlement lists. The control method comprises the following steps: a, determining total-population medical insurance settlement data, insured person information and a plurality of health insurance schemes based on m doctor seeing settlement lists of n insured persons in a medical insurance year; b, determining the number Ta of high-risk crowds based on the age, gender and occupations of insured persons, and determining a reverse selection factor M; c, determining the total insured number K based on the insured number kq of the k risk groups and the annual growth rate L of the insured number; d, determining a previous symptom-related cost ratio factor X of the previous symptom population and a total reimbursement amount Y in a responsibility range based on the total population medical insurance settlement data; and e, determining the pricing net cost W based on the reimbursement total amount Y in the responsibility range, the previous symptom-related cost ratio factor X of the previous symptom population, the reverse selection factor M, the total insured number K and the expansion factor P. The method is low in implementation cost, accurate in prediction, high in practicability, wide in applicability and extremely high in value.

Description

technical field [0001] The invention belongs to the field of medical insurance, and in particular relates to a control method and device for predicting and pricing net costs based on medical insurance medical settlement bills. Background technique [0002] As a product designed to fill the gap between commercial health insurance and the basic medical security system in supplementary medical insurance, Huimin Insurance will be fully established by 2030, with basic medical insurance as the main body and medical assistance as the backing, supplementary medical insurance, and commercial insurance. Health insurance, charitable donations, and medical mutual assistance develop together in a medical security system, with fair and moderate treatment guarantees, stable and sustainable fund operations, optimized and convenient management services, and a significant improvement in the modernization of medical insurance governance. Huimin Insurance will exist for a long time as a bridge ...

AI Technical Summary

Problems solved by technology

[0004] However, the adverse selection ratio of high-risk groups, the forecast of the number of insured persons, inflation factors, factors related to the cost of major pre-existing diseases, and inflation factors are different. The difference in the impact of personal burden of medical expenses will affect the accuracy of prediction of personal burden in the city dimension under different insurance participation rates

[0005] At present, there is no technical solution that can solve the above-mentioned technical problems, specifically, there is no control method and device for predicting the net cost of pricing based on medical insurance medical bills

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