Information processing system, information processing method, and program

Abstract

This system provides an information processing system that is easy to adapt to revisions in calculation methods, less prone to bugs, and enables efficient calculation processing. [Solution] The system comprises a first acquisition unit that acquires one or more calculation target items, a second acquisition unit that acquires related items associated with each calculation target item, a third acquisition unit that acquires calculation information corresponding to each calculation target item and related item, a calculation formula generation unit that generates a calculation formula by combining the calculation information corresponding to each calculation target item and related item, and a calculation unit that executes the calculation formula.

Description

Technical Field

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[0001] The present invention relates to an information processing system, an information processing method, and a program for supporting the calculation of remuneration for care, medical care, and disability welfare (hereinafter referred to as "care, etc.").

Background Art

[0002] For service providers of care, etc., the business related to the billing of remuneration for care, etc. (hereinafter referred to as "care remuneration") is a major burden. For this reason, systems for supporting the calculation of care remuneration have been proposed conventionally (for example, Patent Documents 1 and 2).

[0003] Insurance for care, etc. has many types of services, and even for the same service, the calculation method varies depending on the situation of the user or the facility (level of care required, region, etc.), so the calculation of care remuneration is complicated. In addition, since the calculation method of care remuneration is revised regularly, it is necessary to respond to the revision each time.

Prior Art Documents

Patent Documents

[0004]

Patent Document 1

Patent Document 2

Summary of the Invention

Problems to be Solved by the Invention

[0005] In conventional systems, a separate program was created for calculating care service fees for each type of service, and the calculation of care service fees was adjusted to accommodate differences in the circumstances of users and service providers. However, with such systems, every time the calculation method was revised, the entire system program, including the calculation programs for all services, had to be modified, which was a heavy burden. Furthermore, modifying so many calculation programs increased the likelihood of errors (bugs). In addition, when calculating care service fees, even if the corresponding service had not actually been provided, the calculation program for all services (which was composed to correspond to the number of care benefit unit service codes (over 20,000)) was executed, and the result of the calculation was used to determine whether or not the corresponding service had been provided, which made the calculation process time-consuming.

[0006] Therefore, the objective of the present invention is to provide an information processing system that can easily adapt to revisions of calculation methods, is less prone to bugs, and enables efficient calculation processing. [Means for solving the problem]

[0007] The information processing system according to the present invention comprises: a first acquisition unit that acquires one or more calculation target items; a second acquisition unit that acquires related items associated with each calculation target item; a third acquisition unit that acquires calculation information corresponding to each calculation target item and related item; a calculation formula generation unit that generates a calculation formula by combining the calculation information corresponding to each calculation target item and related item; and a calculation unit that executes the calculation formula.

[0008] The information processing method according to the present invention comprises the steps of: a computer acquiring one or more items to be calculated; a computer acquiring related items associated with each item to be calculated; a computer acquiring calculation information corresponding to each item to be calculated and each related item; a computer generating a calculation formula by combining the calculation information corresponding to each item to be calculated and each related item; and a computer executing the calculation formula.

[0009] The program according to the present invention causes a computer to function as a first acquisition unit that acquires one or more calculation target items, a second acquisition unit that acquires related items associated with each calculation target item, a third acquisition unit that acquires calculation information corresponding to each calculation target item and related item, a calculation formula generation unit that generates a calculation formula by combining the calculation information corresponding to each calculation target item and related item, and a calculation unit that executes the calculation formula. [Effects of the Invention]

[0010] According to the present invention, it is possible to provide an information processing system that can easily adapt to revisions of calculation methods, is less prone to bugs, and enables efficient calculation processing. [Brief explanation of the drawing]

[0011] [Figure 1] A block diagram showing the configuration of a care fee calculation system 1 according to an embodiment of the present invention. [Figure 2] A block diagram showing the configuration of a care fee calculation server 10 according to an embodiment of the present invention. [Figure 3] A block diagram showing a functional module of a program executed by the processor 11 of the care fee calculation server 10 according to an embodiment of the present invention. [Figure 4] A flowchart of the care fee calculation process by the care fee calculation system 1 according to an embodiment of the present invention. [Figure 5] A diagram illustrating the concept of a calculation formula generated by the care fee calculation system 1 according to an embodiment of the present invention. [Modes for carrying out the invention]

[0012] Next, embodiments for carrying out the present invention will be described in detail with reference to the drawings. Figure 1 is a block diagram showing the configuration of a care fee calculation system 1 (information processing system) according to an embodiment of the present invention. As shown in Figure 1, the care fee calculation system 1 comprises a care fee calculation server 10 and a user terminal 20. The care fee calculation server 10 is connected to the user terminal 20 via a communication network N. The communication network N may be any of the following: the internet, LAN, dedicated line, telephone line, corporate network, mobile communication network, Bluetooth®, WiFi (Wireless Fidelity), other communication lines, or a combination thereof, and may be wired or wireless.

[0013] The long-term care fee calculation system 1 is a system used by personnel of companies providing long-term care services (long-term care, medical care, disability welfare) when calculating long-term care fees (remuneration for long-term care, etc.). The long-term care fee calculation server 10 may be a general-purpose computer, and may consist of a single computer or multiple computers distributed over a communication network N. The long-term care fee calculation server 10 may be installed at a company that provides long-term care services, or at a company that provides the long-term care fee calculation system 1. Furthermore, the long-term care fee calculation server 10 may be built on the cloud.

[0014] The user terminal 20 is a terminal operated by a person in charge at a company providing care services when using the care fee calculation system 1. The user terminal 20 can be any terminal device that can exchange data with the care fee calculation server 10 via the communication network N, such as a personal computer (PC), notebook PC, tablet terminal, smartphone, mobile phone, or personal digital assistant (PDA). The user terminal 20 is equipped with a processor, input devices such as a keyboard and mouse, various operation buttons and a touch panel, a display device such as an LCD display, a communication interface for connecting to the communication network N, and storage resources such as a disk drive or semiconductor memory (ROM, RAM, etc.).

[0015] Figure 2 is a block diagram showing the configuration of the long-term care fee calculation server 10. As shown in Figure 2, the long-term care fee calculation server 10 includes a processor 11, main memory 12, input / output interface 13, communication interface 14, and storage device 15. The storage device 15 is a computer-readable recording medium such as semiconductor memory (e.g., volatile memory or non-volatile memory) or disk media (e.g., magnetic recording medium or magneto-optical recording medium). The storage device 15 stores programs to be executed by the processor 11, as well as various data. The programs are read from the storage device 15 into the main memory 12, interpreted and executed by the processor 11, thereby executing various functions.

[0016] Figure 3 is a block diagram showing the functional modules of a program executed by the processor 11 of the long-term care fee calculation server 10. As shown in Figure 3, the functional modules executed by the processor 11 of the long-term care fee calculation server 10 include a first acquisition unit 101, a second acquisition unit 102, a third acquisition unit 103, a calculation formula generation unit 104, and a calculation unit 105.

[0017] Furthermore, as shown in Figure 3, the storage device 15 implements a unit number calculation information storage unit 151 and an arithmetic information storage unit 152.

[0018] The unit calculation information storage unit 151 stores information on the method of calculating the unit number (points) for each service. Nursing care benefits are calculated by calculating the unit number for each service and multiplying the unit number by the unit price. The unit number is calculated by the sum of the basic unit number for each service and the unit number calculated according to the addition and subtraction items set for each service. The unit calculation information storage unit 151 stores information on the addition and subtraction items to be referred to in association with the service. The addition and subtraction items referred to by each service can be set based on the information defined in the calculation structure of nursing care benefits. The addition and subtraction items are common items referred to by various services, including additions according to regional classification (such as mountainous areas, etc.) and additions according to the degree of care. Also, among the addition and subtraction items, there are those that add (or subtract) a predetermined unit number when the condition is met, and those that multiply the total unit number by a predetermined coefficient when the condition is met. Note that service codes are also assigned to the addition and subtraction items.

[0019] The operation information storage unit 152 stores the operation details of each service and the addition and subtraction items. The operation details include one arithmetic operation and information on input parameters and output values for the operation. For example, the operation details of a certain service are such that the input parameters are the basic unit number and the number of uses, the operation is the multiplication of the input parameters, and the output value is the multiplication result.

[0020] Next, the nursing care benefit calculation process by the nursing care benefit calculation system 1 will be described using the flowchart of FIG. 4.

[0021] First, the first acquisition unit 101 acquires various types of information necessary for calculating nursing care benefits through external input (step S11). Information from the external source can be received, for example, from the information input via the user terminal 20. It can also be acquired by accessing an external server or the like. The information acquired from the external source includes "service usage information", "user information", "own business office information", and "other business office information".

[0022] "Service usage information" refers to information on the use of care services by a user over a certain period (e.g., monthly). Specifically, it includes information on the number of times each service was used (number of times the service was provided). The services may correspond to service codes (care benefit unit service codes) in care services. The service usage information may be created, for example, based on the contents described in the service usage table for care services, and may include, for example, one or more service codes (items subject to calculation) and information on the number of times each service was used.

[0023] "User information" refers to information about the user, including date of birth, place of residence, and level of care required. "Our own business information" refers to information about the business that provided services to the user, including whether or not it is a satellite business, regional classification, number of staff, and status of staff training. "Other business information" refers to information about businesses other than the business that provided services to the user, including whether or not it is a satellite business, regional classification, and other information. User information, our own business information, and other business information are used in the calculation of the number of units for long-term care fees, including determining the conditions for additions and subtractions.

[0024] Next, the second acquisition unit 102 refers to the unit number calculation information storage unit 151 and acquires the addition / subtraction items (related items) registered in association with the service code acquired in step S11 (step S12). As described above, the number of units for each service is calculated by summing the basic number of units for each service and the number of units calculated according to the addition / subtraction items set for each service.

[0025] Next, the third acquisition unit 103 refers to the calculation information storage unit 152 and acquires the calculation details (calculation information) corresponding to the service code acquired in step S11 and the addition / subtraction items acquired in step S12 (step S13).

[0026] Next, the calculation formula generation unit 104 generates a calculation formula by combining the calculation contents obtained in step S13 (step S14).

[0027] Figure 5 is a diagram illustrating the concept of a calculation formula generated by the calculation formula generation unit 104. The example shown in Figure 5 shows the calculation formula when two service codes, "111113 (Physical Care 1 - Deep)" and "111111 (Physical Care 1)", are obtained in step S11. As shown in Figure 5, the calculation formula can be represented as a directed graph consisting of node n and edges connecting each node n. In Figure 5, nodes n01 to n02 are nodes that show operations corresponding to basic services (Physical Care 1 - Deep, Physical Care 1), and nodes n11 to n28 are nodes of operations corresponding to addition and subtraction items referenced by each service code obtained in step S12. Also, nodes n51 to n53 are nodes of operations that add the input values. The symbols "+" and "×" within each node represent arithmetic operations, the edges pointing to the node represent input parameters, and the edges extending from the node represent output values.

[0028] As shown in Figure 5, the basic service nodes n01 and n02 use the respective basic unit count and service provision count as input parameters and perform multiplication. The respective output values ​​are summed at node n51. Of the input parameters, the basic unit count can be obtained from the calculation information storage unit 152. The service provision count can be obtained from the service usage information storage unit 151.

[0029] In n11 to n12, the "Same Building Deduction 1," one of the addition and subtraction items, is applied. "Same Building Deduction 1" is applied, for example, when a user resides in the same building as the care facility, and whether or not it can be applied can be determined, for example, based on the user's place of residence obtained as user information. In other words, if the conditions for applying "Same Building Deduction 1" are met, such as when the user resides in the building of the care facility, it is incorporated into the calculation formula, and if the conditions for applying "Same Building Deduction 1" are not met, it is not incorporated into the calculation formula. The calculation involves subtracting 10% from the number of units output from n51. As shown in Figure 5, the value to be subtracted (10% of the original number of units) is calculated in node n11, and the subtraction is performed from the number of units in n12.

[0030] Nodes n13 to n14 apply the "Mountainous Area Service Surcharge." This surcharge applies, for example, when a user resides in a mountainous area. Whether or not it can be applied can be determined, for example, based on the user's place of residence obtained as user information. The calculation involves adding 5% to the number of units. As shown in Figure 5, node n13 calculates the value to be added (5% of the original number of units), and n14 performs the addition process.

[0031] Nodes n15 to n17 apply the "Emergency Home Care Surcharge." This surcharge is applied, for example, when emergency home care is provided in response to a user's request. The calculation involves adding 100 units per visit. As shown in Figure 5, node n15 calculates the value to be added (number of visits × 100 units), and n16 to n17 perform the addition process. The number of visits can be obtained from the service usage information storage unit 151.

[0032] Similarly, for n18-n20, the "initial fee" (an additional 200 units per month if the requirements are met) is applied; for n21-n23, the "life function improvement collaboration fee I" (an additional 100 units per session) is applied; and for n24-n26, the "dementia specialist care fee I" (an additional 3 units per day if the care facility meets the requirements) is applied. The number of uses and other information can be obtained from the service usage information storage unit 151.

[0033] Furthermore, n27 calculates the "Treatment Improvement Allowance I" (adding 13.7% of the original value if the care worker meets the requirements), and n28 calculates the "Specific Treatment Improvement Allowance II" (adding 4.2% of the original value if the care worker meets the requirements), and n53 performs the addition process. The value output from n53 becomes the final total number of units.

[0034] Next, the calculation unit 105 calculates the total number of units for long-term care services by executing the calculation formula generated in step S14 (step S15). Long-term care providers can then use the calculated total number of units to process claims for long-term care services.

[0035] As described above, according to this embodiment, in calculating long-term care fees, the service code of the basic service provided is obtained, and the addition / subtraction items, which are optional items referenced by each service code, are identified. Then, the calculation formula for the number of long-term care fee units is dynamically generated based on each item and its reference relationship. This makes it possible to generate a calculation formula with the minimum necessary items based on the services actually subject to calculation and their reference relationships, thus enabling efficient calculation processing. Furthermore, according to this embodiment, the optional addition / subtraction items only need to be prepared as a common program that each service can reference as needed, and there is no need to incorporate the logic into the program of each service in advance. This makes it easy to modify the program to respond to revisions in the calculation method, reduces the likelihood of bugs, and makes it easier to find the problematic parts even if bugs do occur. In addition, even if a new service code is added, it can be handled simply by adding definitions for the reference relationships of the addition / subtraction items, thus reducing the burden.

[0036] It should be noted that the present invention is not limited to the embodiments described above, and can be implemented in various other forms without departing from the spirit of the invention. For example, the present invention can be used not only for calculating long-term care fees, but also for calculating various other fee amounts such as medical fees and disability welfare service fees. Furthermore, the above embodiments are merely illustrative in all respects and should not be interpreted restrictively. For example, the order of each processing step described above can be arbitrarily changed or executed in parallel, as long as it does not cause inconsistencies in the processing content. In addition, some of the functions of the long-term care fee calculation server 10 may be executed on the user terminal 20. [Explanation of Symbols]

[0037] 1...Care fee calculation system, 10...Care fee calculation server, 20...User terminal, 11...Processor, 12...Main memory, 13...Input / output interface, 14...Communication interface, 15...Storage device, 101...First acquisition unit, 102...Second acquisition unit, 103...Third acquisition unit, 104...Calculation formula generation unit, 105...Calculation unit, 151...Unit amount calculation information storage unit, 152...Calculation information storage unit

Claims

1. A first acquisition unit that acquires one or more calculation target items, A second acquisition unit that acquires related items linked to each calculation target item, A third acquisition unit that acquires calculation information corresponding to each calculation target item and related items, A calculation formula generation unit generates a calculation formula by combining calculation information corresponding to each item to be calculated and related items, An information processing system comprising a calculation unit that executes the aforementioned calculation formula.

2. The aforementioned calculation items correspond to the service codes for which long-term care fees are calculated. The aforementioned related items correspond to the addition and subtraction items referenced in the compensation calculation structure of each service. The calculation formula generation unit is, The information processing system according to claim 1, which generates a calculation formula for calculating the number of units for calculating long-term care service fees.

3. The calculation formula generation unit is, The information processing system according to claim 1 or 2, wherein the calculation formula is generated by using the calculation target item and the related item as nodes and connecting each node in a directed graph based on the reference relationship from the calculation target item to the related item.

4. The process involves a computer acquiring one or more items to be calculated, The process involves the computer acquiring related items linked to each item being calculated, The process involves a computer acquiring calculation information corresponding to each item to be calculated and related items, The process involves a computer generating a calculation formula by combining calculation information corresponding to each item to be calculated and related items, An information processing method comprising the step of a computer executing the calculation formula.

5. Computers, A first acquisition unit that acquires one or more calculation target items, A second acquisition unit that acquires related items linked to each calculation target item, A third acquisition unit that acquires calculation information corresponding to each calculation target item and related items, A calculation formula generation unit generates a calculation formula by combining calculation information corresponding to each item to be calculated and related items, A program that functions as a calculation unit to execute the aforementioned calculation formula.

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