Remote medical insurance payment collaborative management method based on DRG / DIP

Abstract

The invention relates to the field of medical insurance management, and discloses a DRG / DIP-based remote medical insurance payment collaborative management method, which comprises the following steps of S1, grouping similar cases of remote hospitalization settlement cases of each hospital according to a DRG / DIP technical specification; s2, acquiring to-be-settled information data of a doctor-seeing place through a remote doctor-seeing case management module; s3, analyzing the to-be-settled data through an analysis module, and obtaining a case group corresponding to the to-be-settled data; (S4); analyzing the case information data of the case group and the to-be-settled information data through an analysis module, and judging whether the to-be-settled patient information data is abnormal or not; if yes, an alarm and to-be-settled patient information data are sent to an insured place monitoring module; otherwise, sending group entering and cost information; whether the to-be-settled data is abnormal or not can be automatically judged, the insured place can know the data condition of remote medical treatment payment in time, and the effects of fund calculation, account checking and monitoring management of the insured place on remote medical treatment are achieved.

Description

Technical Field

[0001] The present invention relates to the field of medical treatment and medical insurance management, and in particular to a collaborative management method for medical insurance payment for medical treatment in a different place based on DRG / DIP. Background Art

[0002] As my country's transportation infrastructure gradually improves and population mobility gradually increases, the issue of medical treatment in other places has gradually become an important issue in the medical insurance system; medical treatment in other places refers to the situation where insured persons receive medical treatment and enjoy medical insurance benefits in areas other than the place of insurance due to work, study, visiting relatives, tourism, etc.

[0003] At present, there is no unified charging standard among hospitals across the country. For the same case, different hospital levels, regions, medical service items and drugs used will result in different treatment costs. Among them, DRG and DIP are two different medical insurance payment methods. With the increasing demand for medical treatment in other places, medical treatment in other places under the current DRG / DIP medical insurance payment method faces the problem of rapid growth in medical treatment fund expenditure.

[0004] However, due to the large number of medical treatment locations, the treatment costs in each location are different, and it is difficult for the insured area to monitor the quality of medical services in the location. Summary of the invention

[0005] The purpose of the present invention is to provide a method for coordinating the payment of medical insurance for medical treatment in different places based on DRG / DIP, and solve the following technical problems:

[0006] How can the insured area promptly discover whether the patient information data to be settled is abnormal?

[0007] The purpose of the present invention can be achieved through the following technical solutions:

[0008] A collaborative management method for medical insurance payment for medical treatment in a different place based on DRG / DIP, the collaborative management method comprising the following steps:

[0009] S1: The cases of non-local hospitalization settlement completed by hospitals across the country were divided into a group according to the DRG / DIP technical specifications;

[0010] S2: Obtain the patient information data to be settled at the place of medical treatment through the medical case management module;

[0011] S3: Analyze the patient information data to be settled through the analysis module to obtain a case group corresponding to the patient information data to be settled;

[0012] S4; Analyze the case information data and the patient information data to be settled of the case group through the analysis module to determine whether the patient information data to be settled is abnormal; if abnormal, send an alarm and the patient information data to be settled to the insured location monitoring module; otherwise, send the patient information data to be settled to the out-of-town medical treatment case management module of the insured location, and automatically store the patient information data to be settled in the out-of-town medical treatment case management module of the insured location.

[0013] As a further solution of the present invention: the patient information data to be settled includes the patient's diagnosis information and the amount to be settled; the case information data includes the case diagnosis information, whether it is cured, the treatment cost, whether it relapses and the interval between cure and relapse.

[0014] As a further solution of the present invention: the process of determining whether the patient information data to be settled is abnormal is as follows:

[0015] S10: Analyze the total number of cases, the number of cured cases, and the number of relapsed cases similar to the case group corresponding to the patient information data to be settled in each hospital, and obtain the treatment status index of the case group in each hospital;

[0016] S20: Analyze the cure-recurrence intervals of cases similar to the case group corresponding to the patient information data to be settled in each hospital, and obtain the recurrence status index of the case group in each hospital;

[0017] S30: By analyzing the treatment status index, recurrence status index and treatment cost of each hospital, the comprehensive status index of the case group of each hospital is obtained;

[0018] S40: By analyzing the comprehensive status index of each hospital, the standard treatment cost of this case group was obtained;

[0019] S50: Analyze the amount to be settled of the patient to be settled and the standard treatment fee to determine whether the information data of the patient to be settled is abnormal.

[0020] As a further embodiment of the present invention: the treatment state index is obtained by the formula:

[0021]

[0022] Calculate the number of cases in this group Hospital treatment status index ;

[0023] in, Number The total number of patients in this case group in the hospital; It is the treatment basic status index; Number The number of cured cases in the hospital; Preset ratios for cure rates; Number the number of recurrences in this case group in the hospital; Preset ratios for recurrence rates; is the first weight coefficient; is the second weight coefficient.

[0024] As a further embodiment of the present invention: the relapse status index is obtained by the formula:

[0025]

[0026] Calculate the number of cases in this group Hospital relapse status index ;

[0027] in, Number The serial number of the number of relapses in the hospital; Number Hospital No. The cure-relapse interval of each relapsed person; The preset cure-relapse interval length; is the preset standard deviation; is the relapse basic status index; is the third weight coefficient; is the fourth weight coefficient.

[0028] As a further solution of the present invention: the comprehensive state index is obtained by the formula:

[0029]

[0030] Calculate the number of cases in this group The comprehensive status index of hospitals ;

[0031] in, is the first judgment function, when hour, ;when hour, ; is the first judgment function, when hour, ;when hour, ; is a first preset state index; is a second preset state index; The number of people is preset; Number The average treatment cost of cured patients in the hospital.

[0032] As a further solution of the present invention: the standard cost of the case group is calculated by the formula:

[0033]

[0034] Calculate the standard cost for this case group ;

[0035] in, The comprehensive status index The number of hospitals greater than 0, ; For the Comprehensive status index Hospitals with a value greater than 0 Average cost of treatment per cured person; For the Comprehensive status index The weight coefficient of the hospital is greater than 0.

[0036] As a further solution of the present invention: by formula;

[0037]

[0038] Calculate the Comprehensive status index The weight coefficient of the hospital greater than 0 ;

[0039] in, For the Comprehensive status index The comprehensive status index corresponding to hospitals greater than 0.

[0040] As a further solution of the present invention: the process of judging whether the patient information data to be settled is abnormal is as follows:

[0041]

[0042] Calculate the judgment index ,in, The amount to be settled by the patient; is the preset allowable error value;

[0043] , the patient information data to be settled is abnormal; otherwise, the patient information data to be settled is normal.

[0044] Beneficial effects of the present invention:

[0045] (1) The present invention divides the cases of non-local hospitalization settlement completed by hospitals across the country into a group according to the DRG / DIP technical specifications; then obtains the patient information data to be settled at the place of medical treatment through the non-local medical treatment case management module; then analyzes the patient information data to be settled through the analysis module to obtain the case group corresponding to the patient information data to be settled; finally, analyzes the case information data and the patient information data to be settled of the case group through the analysis module to determine whether the patient information data to be settled is abnormal; if abnormal, sends an alarm and the patient information data to be settled to the insurance participating place monitoring module; otherwise, sends a report to the insurance participating place non-local medical treatment case management module; The module sends the patient information data to be settled, and automatically stores the patient information data to be settled into the out-of-town medical treatment case management module of the insured place; it can automatically determine whether the patient information data to be settled is abnormal, and promptly let the insured place know the data situation of out-of-town medical treatment payment, thus realizing the fund calculation, reconciliation and monitoring management of out-of-town medical treatment in the insured place. There is no need to manually review all the patient information data to be settled. The staff of the insured place only needs to review the abnormal patient information data to be settled, thus reducing the workload of the staff of the insured place, improving the review quality of the abnormal patient information data to be settled in the insured place, and realizing the supervision role of the insured place over out-of-town medical treatment. BRIEF DESCRIPTION OF THE DRAWINGS

[0046] The present invention will be further described below in conjunction with the accompanying drawings.

[0047] Figure 1 The present invention is a method flow chart of an embodiment of the present invention. DETAILED DESCRIPTION

[0048] The following will be combined with the drawings in the embodiments of the present invention to clearly and completely describe the technical solutions in the embodiments of the present invention. Obviously, the described embodiments are only part of the embodiments of the present invention, not all of the embodiments. Based on the embodiments of the present invention, all other embodiments obtained by ordinary technicians in this field without creative work are within the scope of protection of the present invention.

[0049] See also Figure 1 As shown, in one embodiment, a collaborative management method for medical insurance payment for medical treatment in a different place based on DRG / DIP is provided, and the collaborative management method includes the following steps:

[0050] S1: The cases of non-local hospitalization settlement completed by hospitals across the country were divided into a group according to the DRG / DIP technical specifications;

[0051] S2: Obtain the patient information data to be settled at the place of medical treatment through the medical case management module;

[0052] S3: Analyze the patient information data to be settled through the analysis module to obtain a case group corresponding to the patient information data to be settled;

[0053] S4; Analyze the case information data and the patient information data to be settled of the case group through the analysis module to determine whether the patient information data to be settled is abnormal; if abnormal, send an alarm and the patient information data to be settled to the insured monitoring module; otherwise, send the patient information data to be settled to the insured medical case management module, and automatically store the patient information data to be settled in the insured medical case management module;

[0054] Through the above technical solution, this embodiment divides the cases of non-local hospitalization settlement completed by hospitals across the country into a group according to the DRG / DIP technical specifications; then obtains the patient information data to be settled at the place of medical treatment through the non-local medical treatment case management module; then analyzes the patient information data to be settled through the analysis module to obtain the case group corresponding to the patient information data to be settled; finally, analyzes the case information data and the patient information data to be settled of the case group through the analysis module to determine whether the patient information data to be settled is abnormal; if abnormal, sends an alarm and the patient information data to be settled to the monitoring module of the insurance location; otherwise, Then, the patient information data to be settled is sent to the out-of-town medical treatment case management module of the insured place, and the patient information data to be settled is automatically stored in the out-of-town medical treatment case management module of the insured place; it can automatically determine whether the patient information data to be settled is abnormal, and promptly let the insured place know the abnormal patient information data to be settled of out-of-town medical treatment; there is no need to manually review all the patient information data to be settled, and the staff of the insured place only needs to review the abnormal patient information data to be settled, which reduces the workload of the staff of the insured place, improves the quality of the review of the abnormal patient information data to be settled by the insured place, and realizes the supervisory role of the insured place on out-of-town medical treatment;

[0055] It should be noted that the DRG / DIP technical specification is an existing technology and will not be described in detail here.

[0056] As an implementation mode of the present invention, the patient information data to be settled includes patient diagnosis information and the amount to be settled; the case information data includes case diagnosis information, whether the disease is cured, treatment cost, whether the disease relapses, and the interval between cure and relapse;

[0057] It should be noted that the above data acquisition method is an existing technology and will not be described in detail here.

[0058] As an implementation mode of the present invention, the process of determining whether the patient information data to be settled is abnormal is as follows:

[0059] S10: Analyze the total number of cases, the number of cured cases, and the number of relapsed cases similar to the case group corresponding to the patient information data to be settled in each hospital, and obtain the treatment status index of the case group in each hospital;

[0060] S20: Analyze the cure-recurrence intervals of cases similar to the case group corresponding to the patient information data to be settled in each hospital, and obtain the recurrence status index of the case group in each hospital;

[0061] S30: By analyzing the treatment status index, recurrence status index and treatment cost of each hospital, the comprehensive status index of the case group of each hospital is obtained;

[0062] S40: By analyzing the comprehensive status index of each hospital, the standard treatment cost of this case group was obtained;

[0063] S50: Analyze the amount to be settled of the patient to be settled and the standard treatment fee to determine whether the information data of the patient to be settled is abnormal;

[0064] Through the above technical scheme, this embodiment first analyzes the total number of cases, the number of cured cases, and the number of relapsed cases similar to the case group corresponding to the patient information data to be settled in each hospital, and obtains the treatment status index of the case group of each hospital; then, the relapse status index of the case group of each hospital is obtained by analyzing the cure-relapse interval of the cases similar to the case group corresponding to the patient information data to be settled in each hospital; then, the comprehensive status index of the case group of each hospital is obtained by analyzing the treatment status index, relapse status index and treatment cost of each hospital; then, the standard treatment cost of the case group is obtained by analyzing the comprehensive status index of each hospital; finally, the amount to be settled of the patient to be settled is analyzed with the standard treatment cost to determine whether the patient information data to be settled is abnormal; the standard treatment cost is determined according to the comprehensive status index of each hospital, so that the standard treatment cost is more reasonable, and the hospital with better treatment effect in each case group can be understood through the comprehensive status index, and the treatment method of the hospital can be promoted to improve the treatment effect of other hospitals, thereby improving the treatment level of hospitals across the country.

[0065] As an embodiment of the present invention, the treatment state index is obtained by the formula:

[0066]

[0067] Calculate the number of cases in this group Hospital treatment status index ;

[0068] in, Number The total number of patients in this case group in the hospital; It is the treatment basic status index; Number The number of cured cases in the hospital; Preset ratios for cure rates; Number the number of recurrences in this case group in the hospital; Preset ratios for recurrence rates; is the first weight coefficient; is the second weight coefficient;

[0069] Through the above technical solution, this embodiment Number The actual cure rate of this case group in the hospital; Number The difference between the actual cure rate of the case group in the hospital and the preset cure rate ratio; When The actual cure rate of this case group in the hospital exceeds the preset cure rate ratio, number The hospital has a good treatment effect on this case group; therefore, the number Treatment status index Greater than the treatment baseline index ;serial number The difference between the actual cure rate of this case group in the hospital and the preset cure rate ratio The larger the number, Treatment status index The bigger; when When The actual cure rate of this case group in the hospital is less than the preset cure rate ratio; therefore, Treatment status index Less than the treatment baseline index ;serial number The absolute value of the difference between the actual cure rate of the case group in the hospital and the preset cure rate ratio The larger the number, Treatment status index The smaller; Number the actual recurrence rate for this group of cases in the hospital; Number The difference between the preset recurrence rate and the actual recurrence rate of the case group in the hospital; When The pre-set recurrence rate of this case group in the hospital is greater than the actual recurrence rate, so the number The hospital has a good treatment effect on this case group, with fewer recurrences; therefore, the treatment status index Greater than the treatment baseline index ;serial number The difference between the preset recurrence rate and the actual recurrence rate of this case group in the hospital The larger the number, Treatment status index The bigger; when When The actual recurrence rate of this case group in the hospital is greater than the preset recurrence rate ratio; therefore, Treatment status index Less than the treatment baseline index ;serial number The absolute value of the difference between the preset recurrence rate and the actual recurrence rate of this case group in the hospital The larger the number, Treatment status index The smaller;

[0070] It should be noted that the treatment basic status index , preset cure rate ratio , recurrence rate preset ratio , the first weight coefficient and the second weight coefficient It is a preset value obtained based on experience and will not be described in detail here.

[0071] As an embodiment of the present invention, the relapse status index is calculated by the formula:

[0072]

[0073] Calculate the number of cases in this group Hospital relapse status index ;

[0074] in, Number The serial number of the number of relapses in the hospital; Number Hospital No. The cure-relapse interval of each relapsed person; To preset the cure-relapse interval; is the preset standard deviation; is the relapse basic status index; is the third weight coefficient; is the fourth weight coefficient;

[0075] Through the above technical solution, this embodiment Number Hospital The average cure-relapse interval for each relapsed person; the cure-relapse interval is the time from the time of discharge from hospital to the time of diagnosis of relapse; Number Hospital The difference between the average cure-relapse interval of the relapsed patients and the preset cure-relapse interval; Description Number The average cure-relapse interval of patients with relapse in the hospital is longer than the preset cure-relapse interval; Description number The hospital has good treatment effect, so it is numbered Relapse Status Index The bigger; when Description Number Hospital The average cure-relapse interval of the relapsed patients is less than the preset cure-relapse interval; The hospital treatment effect is poor, so the number Relapse Status Index The smaller; Number The standard deviation of the cure-recurrence interval of patients with relapse in the hospital, To preset standard deviation and number The difference in the standard deviation of the cure-recurrence interval of patients with relapse in the hospital; when Explanation: The preset standard deviation is greater than the number The standard deviation of the cure-relapse interval of patients with relapse in the hospital; Description number The treatment effect of the hospital is relatively stable, so the number Relapse Status Index The bigger; when Explanation: The preset standard deviation is less than the number The standard deviation of the cure-relapse interval of patients with relapse in the hospital; Description number The treatment effect of the hospital is relatively unstable, so the number Relapse Status Index The smaller;

[0076] It should be noted that the preset cure-recurrence interval , preset standard deviation , Relapse Basic Status Index , the third weight coefficient and the fourth weight coefficient It is a preset value obtained based on experience and will not be described in detail here.

[0077] As an embodiment of the present invention, the comprehensive state index is obtained by the formula:

[0078]

[0079] Calculate the number of cases in this group The comprehensive status index of hospitals ;

[0080] in, is the first judgment function, when hour, ;when hour, ; is the first judgment function, when hour, ;when hour, ; is a first preset state index; is a second preset state index; The number of people is preset; Number The average cost of treatment for cured patients in the hospital;

[0081] Through the above technical solution, this embodiment Number The difference between the total number of cases in the hospital and the preset number; When The total number of patients in this case group in the hospital is greater than the preset number, indicating that the number The hospital has enough patients in this case group; indicate the number The hospitals have enough cases to conduct the assessment to ensure the accuracy of the assessment results. ;when When The total number of patients in this case group in the hospital is less than the preset number, indicating that the number The hospital has insufficient number of patients in this case group; Hospitals do not have enough cases to conduct assessments, and the assessment results are inaccurate. ;when When The treatment status index of this case group in the hospital Greater than the first preset state index , the first preset state index Greater than the treatment baseline index , description number The hospital has good treatment effect; ; The larger the number, The comprehensive status index of hospitals The bigger; when When The treatment status index of this case group in the hospital Less than the first preset state index , description number The hospital treatment effect is poor; ;serial number The comprehensive status index of hospitals for ;when When The relapse status index of this case group in the hospital Greater than the second preset state index , the second preset state index Greater than the relapse baseline index , description number The hospital has good treatment effect; ; The larger the number, The comprehensive status index of hospitals The bigger; when When The relapse status index of this case group in the hospital Less than the second preset state index , description number The hospital treatment effect is poor; ;serial number The comprehensive status index of hospitals for ; Average cost of treatment The smaller the number The comprehensive status index of hospitals The bigger;

[0082] It should be noted that the first preset state index , the second preset state index and preset number of people It is a preset value obtained based on experience and will not be described in detail here.

[0083] As an embodiment of the present invention, the standard cost of the case group is calculated by the formula:

[0084]

[0085] Calculate the standard cost for this case group ;

[0086] in, The comprehensive status index The number of hospitals greater than 0, ; For the Comprehensive status index Hospitals with a value greater than 0 Average cost of treatment per cured person; For the Comprehensive status index The weight coefficient of the hospital is greater than 0;

[0087] Through the above technical solution, this embodiment uses the formula Calculate the standard cost for this case group ; For the Comprehensive status index The weighted cost of the average treatment cost of the number of cured people in the hospital greater than 0; the standard cost of this case group is evaluated by the cost of the hospital with better treatment effect on this case group;

[0088] It should be noted that Comprehensive status index The average cost of treatment for cured patients in hospitals greater than 0 The method of obtaining is prior art and will not be described in detail here.

[0089] As an implementation mode of the present invention, through the formula;

[0090]

[0091] Calculate the Comprehensive status index The weight coefficient of the hospital greater than 0 ;

[0092] in, For the Comprehensive status index The comprehensive status index corresponding to hospitals greater than 0;

[0093] Through the above technical solution, this embodiment For the Comprehensive status index The comprehensive status index of the hospital is greater than 0; Comprehensive status index The comprehensive status index of the hospital is greater than 0 The larger the Comprehensive status index The hospital with a value greater than 0 has a higher cost performance; Comprehensive status index The comprehensive status index of the hospital is greater than 0 The smaller the Comprehensive status index The hospitals with a value greater than 0 have lower cost performance; for Comprehensive status index The total cumulative value of the comprehensive status index corresponding to hospitals greater than 0; For the Comprehensive status index The comprehensive status index of hospitals greater than 0 is Comprehensive status index The ratio of the total cumulative value of the comprehensive status index corresponding to the hospitals greater than 0; Comprehensive status index The comprehensive status index of hospitals greater than 0 The bigger, the Comprehensive status index The weight coefficient of the hospital greater than 0 The larger the value, the greater the weight coefficient of the hospital with better treatment effect. Comprehensive status index The comprehensive status index of hospitals greater than 0 The smaller, the Comprehensive status index The weight coefficient of the hospital greater than 0 The smaller it is, the smaller the weight coefficient of the hospital with worse treatment effect is, making the standard treatment cost more reasonable.

[0094] As an implementation mode of the present invention, the process of determining whether the patient information data to be settled is abnormal is as follows:

[0095]

[0096] Calculate the judgment index ,in, The amount to be settled by the patient; is the preset allowable error value;

[0097] , the patient information data to be settled is abnormal; otherwise, the patient information data to be settled is normal;

[0098] Through the above technical solution, this embodiment The difference between the patient's pending settlement amount and the standard fee for this case group; When the patient's pending settlement amount does not have the standard fee for this case group; there is no abnormality; therefore , , ;when When the patient's pending settlement amount exceeds the standard fee for that case group, there may be anomalies; ;when When , it means that the difference between the patient's pending settlement amount and the standard fee of the case group is within the preset allowable error value and there is no abnormality; ;when When the patient's pending settlement amount and the standard fee of the case group exceed the preset allowable error value, it means that there is an abnormality; ;

[0099] It should be noted that the preset allowable error value It is a preset value obtained based on experience and will not be described in detail here.

[0100] The off-site medical treatment case management module includes a data storage unit, an insurance location supervision unit and a medical treatment location management unit;

[0101] The data storage unit is used to store and save remote medical treatment data;

[0102] The medical treatment location management unit is used to send the off-site medical treatment data to the supervision units of each insurance location;

[0103] The insurance location supervision unit is used to supervise the out-of-town medical treatment data of local insured persons;

[0104] Through the above technical scheme, the out-of-town medical treatment data in this embodiment includes the medical information, expense details, list upload status, fund settlement results, settlement list quality control results and other data generated during the out-of-town medical treatment process. By using the national medical insurance information platform to collect and transfer data, the overall data within the province and across provinces is connected; at the same time, the data of the medical treatment location of the insured place is connected, and the application scenarios that can be realized include refined monitoring of the overall medical treatment flow, calculation of abnormal disease spectrum across provinces and regions, and coordinated supervision of out-of-town medical treatment.

[0105] The above is a detailed description of an embodiment of the present invention, but the content is only a preferred embodiment of the present invention and cannot be considered to limit the scope of implementation of the present invention. All equivalent changes and improvements made within the scope of the present invention should still fall within the scope of the patent coverage of the present invention.

Claims

1. A collaborative management method for medical insurance payment for non-local medical treatment based on DRG / DIP, including, characterized in that: The collaborative management method comprises the following steps: S1: The cases of non-local hospitalization settlement completed by hospitals across the country were divided into a group according to the DRG / DIP technical specifications; S2: Obtain the patient information data to be settled at the place of medical treatment through the medical case management module; S3: Analyze the patient information data to be settled through the analysis module to obtain a case group corresponding to the patient information data to be settled; S4; Analyze the case information data and the patient information data to be settled of the case group through the analysis module to determine whether the patient information data to be settled is abnormal; if abnormal, send an alarm and the patient information data to be settled to the insured location monitoring module; otherwise, send the patient information data to be settled to the out-of-town medical treatment case management module of the insured location, and automatically store the patient information data to be settled in the out-of-town medical treatment case management module of the insured location.

2. The DRG / DIP-based collaborative management method for medical insurance payment for non-local medical treatment according to claim 1 is characterized in that: The patient information data to be settled includes the patient's diagnosis information and the amount to be settled; the case information data includes the case diagnosis information, whether the patient is cured, the cost of treatment, whether the patient relapses, and the duration of the cure-relapse interval.

3. The DRG / DIP-based collaborative management method for medical insurance payment for non-local medical treatment according to claim 2 is characterized in that: The process of judging whether the patient information data to be settled is abnormal is as follows: S10: Analyze the total number of cases, the number of cured cases, and the number of relapsed cases similar to the case group corresponding to the patient information data to be settled in each hospital, and obtain the treatment status index of the case group in each hospital; S20: Analyze the cure-recurrence intervals of cases similar to the case group corresponding to the patient information data to be settled in each hospital, and obtain the recurrence status index of the case group in each hospital; S30: By analyzing the treatment status index, recurrence status index and treatment cost of each hospital, the comprehensive status index of the case group of each hospital is obtained; S40: By analyzing the comprehensive status index of each hospital, the standard treatment cost of this case group was obtained; S50: Analyze the amount to be settled of the patient to be settled and the standard treatment fee to determine whether the information data of the patient to be settled is abnormal.

4. The DRG / DIP-based collaborative management method for medical insurance payment for non-local medical treatment according to claim 3 is characterized in that: The therapeutic state index is given by the formula: ； Calculate the number of cases in this group Hospital treatment status index ; in, Number The total number of patients in this case group in the hospital; It is the treatment basic status index; Number The number of cured cases in the hospital; Preset ratios for cure rates; Number the number of recurrences in this case group in the hospital; Preset ratios for recurrence rates; is the first weight coefficient; is the second weight coefficient.

5. The DRG / DIP-based collaborative management method for medical insurance payment for non-local medical treatment according to claim 4 is characterized in that: The relapse status index is given by the formula: ； Calculate the number of cases in this group Hospital relapse status index ; in, Number The serial number of the number of relapses in the hospital; Number Hospital No. The cure-relapse interval of each relapsed person; To preset the cure-relapse interval; is the preset standard deviation; is the relapse basic status index; is the third weight coefficient; is the fourth weight coefficient.

6. The DRG / DIP-based collaborative management method for medical insurance payment for non-local medical treatment according to claim 5 is characterized in that: The comprehensive status index is obtained by the formula: ； Calculate the number of cases in this group The comprehensive status index of hospitals ; in, is the first judgment function, when hour, ;when hour, ; is the first judgment function, when hour, ;when hour, ; is a first preset state index; is a second preset state index; The number of people is preset; Number The average treatment cost of cured patients in the hospital.

7. The DRG / DIP-based collaborative management method for medical insurance payment for non-local medical treatment according to claim 6 is characterized in that: The standard cost for this case group is given by the formula: ； Calculate the standard cost for this case group ; in, The comprehensive status index The number of hospitals greater than 0, ; For the Comprehensive status index Hospitals with a value greater than 0 Average cost of treatment per cured person; For the Comprehensive status index The weight coefficient of the hospital is greater than 0.

8. The DRG / DIP-based collaborative management method for medical insurance payment for non-local medical treatment according to claim 7 is characterized in that: By formula; ； Calculate the Comprehensive status index The weight coefficient of the hospital greater than 0 ; in, For the Comprehensive status index The comprehensive status index corresponding to hospitals greater than 0.

9. The DRG / DIP-based collaborative management method for medical insurance payment for non-local medical treatment according to claim 8 is characterized in that: The process of judging whether the patient information data to be settled is abnormal is as follows: ； Calculate the judgment index ,in, The amount to be settled by the patient; is the preset allowable error value; , the patient information data to be settled is abnormal; otherwise, the patient information data to be settled is normal.

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