Insurance Support System

Abstract

To provide an insurance support system suitable for increasing the incentive for dental clinics to provide preventive dentistry to their patients. [Solution] In a system in which a mutual aid support server, clinic terminals of multiple dental clinics, and multiple patient terminals are communicably connected, the mutual aid support server 100 registers, for each dental clinic, contract information related to the mutual aid contract in a storage device 42 in association with the clinic ID and patient ID, and registers, in association with the clinic ID and patient ID, benefit claim information related to benefit claims and performance information related to the performance of dental treatment in the storage device 42, and generates benefit information related to benefit points or benefits for the dental clinic and patient related to the benefit claim based on the contract information, benefit claim information, and performance information in the storage device 42. As a result, if the degree or frequency of treatment for a patient decreases, the dental clinic's mutual aid premium income increases, and this can provide a greater incentive for dental clinics to engage in preventive dentistry for patients than before.

Description

[Technical Field]

[0001] The present invention relates to a system for supporting insurance underwriting, and more particularly to an insurance support system suitable for dental clinics to increase the incentives for patients to engage in preventive dentistry. [Background technology]

[0002] BACKGROUND ART Conventionally, as a technology for supporting insurance underwriting, for example, the technology described in Patent Document 1 is known.

[0003] The technology described in Patent Document 1 compares the patient's discretionary medical expenses with the amount of life insurance payment to the patient that should serve as collateral based on the life insurance information storage unit when the patient of a dental clinic is an insured person with a dental rider. Then, based on the results of this comparison, it determines whether to cover a portion of the medical expenses in the payment of discretionary medical expenses to the dental clinic, and whether to advance the discretionary medical expenses to the dental clinic on behalf of the insured person, and calculates the method and amount for doing so. [Prior art documents] [Patent documents]

[0004] [Patent Document 1] Japanese Patent Application Laid-Open No. 2003-256565 Summary of the Invention [Problem to be solved by the invention]

[0005] However, the technology described in Patent Document 1 has the problem that dental clinics do not have an incentive to provide preventive dentistry to their patients. In other words, with the technology described in Patent Document 1, because insurance payments can be used to pay for optional medical treatment, dental clinics may have an incentive to recommend expensive or frequent optional treatments, but this works against dental clinics' efforts to provide preventive dentistry to patients and to minimize the need for treatment in the future. This is because if a patient's teeth are healthy, medical fee income will be lower.

[0006] Therefore, the present invention was made with a focus on the unresolved issues of the conventional technology, and aims to provide an insurance support system that is suitable for dental clinics to increase the incentive for patients to engage in preventive dentistry. [Means for solving the problem]

[0007] [Invention 1] In order to achieve the above-mentioned object, the insurance support system of Invention 1 is an insurance support system that supports insurance underwriting, and is equipped with: a contract information registration means that, for each of a plurality of dental clinics, registers contract information regarding an insurance contract in which the dental clinic is the insurer and patients who visit the dental clinic are insured, and the insured provides benefits based on the performance of dental treatment received by the insurer or by a dental clinic approved by the insurer, in a storage means, correlating the contract information with insurer information regarding the insurer and insured information regarding the insured; a benefit claim information registration means that registers in the storage means benefit claim information regarding a claim for benefits related to the insurance contract and performance information regarding the performance of dental treatment received by the insurer related to the claim or by a dental clinic approved by the insurer, in correspondence with the insurer information regarding the insured; and a benefit information generation means that generates benefit information regarding the benefits related to the insurance contract for the insurer and the insured related to the benefit claim, based on the contract information, benefit claim information, and performance information in the storage means.

[0008] With this configuration, the contract information is registered in the storage means by the contract information registration means, and the benefit claim information and performance information are registered in the storage means by the benefit claim information registration means. Then, the benefit information generation means generates benefit information based on the contract information, benefit claim information, and performance information.

[0009] Here, in understanding the technical scope of the present invention, "insurance contract," "insurer," "insured," and "insurance premium" refer to the "insurance contract," "insurer," "insured," and "insurance premium" stipulated in Article 2 of the Insurance Act, which includes "mutual aid contract," "mutual aid recipient," "mutual aid recipient," and "mutual aid premium." In other words, the term "insurance" described in the claims and in the "Means for Solving the Problems" section is a broader term that includes mutual aid and insurance in the narrow sense.

[0010] Dental care also includes, for example, dental diagnosis, treatment, preventive care, surgery, and other medical care, as well as medical care covered by insurance, private medical care, and other methods.

[0011] The storage means stores the contract information by any means and at any time, and may store the contract information in advance, or may store the contract information by input from an external source during operation of the system without storing the contract information in advance. The same applies to the request information storage means and to other storage means hereinafter.

[0012] Furthermore, storing contract information in association with insurer information includes, for example, (1) storing contract information and insurer information in a direct association, such as registering them in the same record, and (2) storing them via one or more pieces of intermediate information, such as providing a table for registering contract information and intermediate information in association with each other, and a table for registering insurer information and intermediate information in association with each other. In other words, any data structure can be adopted as long as it is possible to trace contract information from insurer information. Note that contract information only needs to be stored in a storage means in association with insurer information, and it is not necessarily required that insurer information be stored in the storage means. The same concept of storing information in association with each other applies hereinafter.

[0013] The system may be realized as a single device, apparatus, terminal, or other device, or as a network system in which multiple devices, apparatus, terminals, or other devices are communicatively connected. In the latter case, each component may belong to any of the multiple devices as long as they are communicatively connected.

[0014] [Invention 2] Furthermore, the insurance support system of Invention 2 is the insurance support system of Invention 1, wherein the contract information includes insured tooth information regarding which of the insured's teeth are eligible for benefits and whether or not or to what extent benefits will be provided, and the performance information is performance information regarding the performance of treatment the insured has received from the insurer for the teeth eligible for benefits.

[0015] With this configuration, the benefit information generation means generates benefit information for the insurer and insured person related to the benefit claim based on insured tooth information, benefit claim information, and performance information regarding the teeth that are eligible for benefits from the insurer and the treatment results received by the insured person regarding whether or not benefits will be provided or the extent of the benefits.

[0016] [Invention 3] Furthermore, the insurance support system of Invention 3 is the insurance support system of either Invention 1 or 2, wherein the benefit information is point information relating to points, and the system comprises an expense claim information registration means for registering expense claim information relating to the expense claim made by the insurer to the insured in the storage means in association with insurer information relating to the insurer and insured information relating to the insured, a point usage information registration means for registering point usage information relating to the use of points in the storage means in association with insurer information relating to the insurer who is the point recipient and insured information relating to the insured who applies to use the points, and a settlement information generation means for generating settlement information for the expense for the insurer and insured pertaining to the expense claim based on the expense claim information and point usage information in the storage means.

[0017] With this configuration, the benefit information generating means generates point information related to points. The expense claim information registering means registers the expense claim information in the storage means, and the point usage information registering means registers the point usage information in the storage means. Then, the settlement information generating means generates settlement information based on the expense claim information and the point usage information. [Effects of the Invention]

[0018] As explained above, according to the insurance support system of Invention 1, dental clinics, which are insurers, can increase their insurance premium income if the extent or frequency of treatments for insured patients decreases, thereby providing dental clinics with more incentive than before to provide preventive dentistry to their patients.

[0019] Furthermore, according to the insurance support system of Invention 2, it is possible to set whether or not insurance will be applied and the degree of coverage for each tooth of the insured person, so that dental clinics that are aware of the condition of their patients' teeth can control insurance risks as insurers.

[0020] Furthermore, according to the insurance support system of Invention 3, benefits related to the insurance contract can be received as points and used for dental treatment at a dental clinic, etc., so claims, benefits, and usage related to the insurance contract can be carried out seamlessly. [Brief explanation of the drawings]

[0021] [Figure 1] FIG. 1 is a block diagram showing a configuration of a network system. [Figure 2] FIG. 2 is a diagram illustrating the hardware configuration of a mutual aid support server 100. [Figure 3] This is a table showing the contents of the main contract and special provisions of the mutual aid agreement. [Figure 4] This is a table showing the purpose and concept of the underwriting standards and the benefit rates for each tooth. [Figure 5] 3A to 3C are diagrams illustrating data structures of various tables. [Figure 6] This is a diagram showing the process for a dental clinic to introduce and provide mutual aid. [Figure 7] This is a diagram showing the process when a patient visits a dental clinic for preventive care and receives benefits. [Figure 8] FIG. 1 is a diagram showing the flow when a patient receives treatment at a dental clinic and receives benefits. DETAILED DESCRIPTION OF THE INVENTION

[0022] An embodiment of the present invention will be described below, with reference to Figures 1 to 8 showing the embodiment. In this embodiment, we will explain the case where a mutual aid plan (hereinafter simply referred to as "mutual aid") is underwritten, in which a dental clinic is the insured party and patients who visit the dental clinic are the insured party, and the insured party receives benefits based on the results of dental treatment received by the insured party (hereinafter simply referred to as "mutual aid"), and the case where a service provider provides each dental clinic with a service for underwriting and managing the mutual aid plan (hereinafter referred to as "management service").

[0023] [Configuration of this embodiment] First, the configuration of this embodiment will be described. FIG. 1 is a block diagram showing the configuration of a network system.

[0024] As shown in Figure 1, the Internet 199 is communicably connected to a mutual aid support server 100 that supports the underwriting of mutual aid, a dental clinic terminal 200 used by each of a plurality of dental clinics, and a patient terminal 300 used by each of a plurality of patients.

[0025] [Mutual aid support server 100] Next, the hardware configuration of the mutual aid support server 100 will be described.

[0026] FIG. 2 is a diagram showing the hardware configuration of the mutual aid support server 100. As shown in FIG. As shown in Figure 2, the mutual aid support server 100 is composed of a CPU (Central Processing Unit) 30 that controls calculations and the entire system based on a control program, a ROM (Read Only Memory) 32 that stores the control program etc. of the CPU 30 in advance in a specified area, a RAM (Random Access Memory) 34 for storing data read from the ROM 32 etc. and calculation results required in the calculation process of the CPU 30, and an I / F (Interface) 38 that mediates the input and output of data to external devices, and these are connected to each other and capable of sending and receiving data by a bus 39, which is a signal line for transferring data.

[0027] The I / F 38 is connected to external devices such as an input device 40 that serves as a human interface and is made up of a keyboard, mouse, etc., through which data can be input, a storage device 42 that stores data, tables, etc. as files, and a display device 44 that displays a screen based on an image signal. The I / F 38 functions as a network adapter, and is connected to a signal line for connection to the Internet 199.

[0028] [Clinic terminal 200] Next, the hardware configuration of the clinic terminal 200 will be described. The clinic terminal 200, like the mutual aid support server 100, has a hardware configuration similar to that of a general computer, with a CPU, ROM, RAM, I / F, etc. connected via a bus. The clinic terminal 200 can be configured as, for example, a desktop PC, a smartphone, or a tablet terminal.

[0029] [Patient terminal 300] Next, the hardware configuration of the patient terminal 300 will be described. The patient terminal 300, like the mutual aid support server 100, has a hardware configuration similar to that of a general computer, with a CPU, ROM, RAM, I / F, etc. connected via a bus. The patient terminal 300 can be configured as, for example, a desktop PC, a smartphone, or a tablet terminal.

[0030] [Contents of Mutual Aid] Next, we will explain the contents of the mutual aid. Figure 3 is a table showing the contents of the mutual aid agreement's main contract and special provisions.

[0031] As shown in Figure 3, a mutual aid contract consists of a main contract, which is mandatory, and special clauses, which are optional.

[0032] The main contract includes coverage for dental visits to a dental clinic for preventive treatment (hereinafter referred to as "preventive visits") as part of dental care, and coverage for treatment as part of dental care. The coverage for preventive visits, for example, includes a set benefit point (3,000 points in the example of Figure 3), and for preventive visits, the insured person is paid 3,000 points for each preventive visit, up to a maximum of two times per year. The coverage for treatment, for example, includes a set benefit amount (50,000 yen, 50,000 yen, 100,000 yen, and 200,000 yen for each type of treatment in the example of Figure 3). For treatment, the insured person is paid a set benefit amount for each treatment. The main contract also includes a set mutual aid premium (1,500 yen per month in the example of Figure 3).

[0033] The rider includes, for example, coverage for whitening or cosmetic treatment. The coverage for whitening or cosmetic treatment includes, for example, a predetermined benefit (15,000 yen in the example of FIG. 3) and a predetermined insurance premium (800 yen per month in the example of FIG. 3). If a patient fulfills certain conditions (for example, not having undergone any treatment for a year), the patient can receive a discount on whitening or cosmetic treatment equivalent to the benefit.

[0034] Figure 4 is a table showing the purpose and concept of the underwriting criteria and the benefit rates for each tooth. For the main contract, the benefit rate can be set for each patient's tooth, as shown in Figure 4. This means that patients who receive treatment will be paid the amount calculated by multiplying the benefit amount set for that treatment by the benefit rate set for the tooth that was the subject of treatment.

[0035] In the example of Figure 4, four levels of benefit rates are set depending on the condition of the patient's teeth: 100%, 70%, 30%, and 0%. For example, if root canal treatment as shown in Figure 4 is performed on a tooth set at 100%, 100,000 yen x 100% = 100,000 yen will be paid, and if the same treatment is performed on a tooth set at 30%, 100,000 yen x 30% = 30,000 yen will be paid.

[0036] [Storage device 42] Next, the data structure of the storage device 42 will be described. The storage device 42 stores various tables.

[0037] FIG. 5 shows the data structures of various tables. As shown in Fig. 5(a), one record is registered for each dental clinic in the dental clinic information registration table 400. Each record contains a clinic ID for identifying the dental clinic, the name of the dental clinic, the address of the dental clinic, and other information about the dental clinic.

[0038] A patient information registration table 402 is provided for each dental clinic. As shown in Fig. 5(b), one record is registered for each patient in the patient information registration table 402. Each record includes a patient ID for identifying the patient, the patient's name, the patient's date of birth, the patient's gender, the patient's contact information (e.g., email address or phone number), the patient's account information, and other information related to the patient.

[0039] 5(c), one record is registered for each dental clinic that receives the operational service in the service information registration table 404. Each record contains the clinic ID of the dental clinic that receives the operational service, the date on which the operational service will begin (start date), the coverage of the mutual aid insurance that the dental clinic can underwrite, the mutual aid insurance terms and conditions, and other information related to the operational service.

[0040] A contract information registration table 406 is provided for each dental clinic. As shown in Fig. 5(d), the contract information registration table 406 has one record registered for each patient who has joined the mutual aid plan. Each record contains the patient ID of the patient who has joined the mutual aid plan, the date of joining the mutual aid plan (enrollment date), the coverage details of the mutual aid plan to which the patient has joined, and other information related to the mutual aid contract.

[0041] A tooth information registration table 408 is provided for each dental clinic. As shown in Figure 5(e), the tooth information registration table 408 has one record registered for each patient enrolled in the mutual aid insurance and each tooth of that patient. Each record contains the patient ID, tooth ID for identifying the patient's tooth, benefit rate, and other information related to the patient's tooth.

[0042] 5(f), one record is registered for each benefit claim in the claim information registration table 410. Each record includes a claim ID for identifying the benefit claim, the patient ID of the patient who made the claim, the clinic ID of the dental clinic where the patient received dental treatment, the date on which the claim was made (claim date), benefit points paid based on the claim, the benefit amount paid based on the claim, the date on which the dental treatment that caused the claim was received (treatment date), the tooth ID of the tooth that caused the claim, the details of the dental treatment that caused the claim, the file name of the receipt for the dental treatment that caused the claim, and other information related to the benefit claim.

[0043] 5(g), one record is registered for each acquisition or use of points in the point history information registration table 412. Each record includes the patient ID of the patient who acquired or used points, the clinic ID of the dental clinic where the patient acquired or used points, the date the points were acquired (acquisition date) or used (use date), the points acquired, the points used, the points held, and other information related to points.

[0044] Next, the operation of this embodiment will be described. In the following explanation, the service provider company is referred to as the "operator," the insurer of one mutual aid contract is referred to as the "dental clinic," and the insured person is referred to as the "patient." Furthermore, the clinic ID, patient ID, and tooth ID can be identified by the mutual aid support server 100 when the dental clinic or patient inputs information about the dental clinic, patient, or tooth on the management screen of the mutual aid support server 100. A claim ID is issued by the mutual aid support server 100 for each claim. Furthermore, the information in tables 400 to 412 can be mutually referenced via the clinic ID, patient ID, tooth ID, and claim ID.

[0045] First, we will explain the case where a dental clinic introduces mutual aid. FIG. 6 is a diagram showing the process for a dental clinic to introduce and provide a mutual aid system.

[0046] When a dental clinic introduces a mutual aid system, the procedures and processes are carried out in the order of steps S100 to S108, as shown in Figure 6(a). Of these, information processing is carried out by a computer in step S104. The information processing is carried out by the CPU 30 starting a predetermined program stored in a predetermined area of ​​the ROM 32, and is carried out in accordance with that program.

[0047] In step S100, the dental clinic decides to introduce the mutual aid scheme. In step S102, the insurance company and the dental clinic decide on the coverage details of the mutual aid. For the main contract, coverage details include preventive outpatient visits and points to be paid if preventive outpatient visits are covered, and treatment items, benefits, and insurance premiums if treatment is covered. Furthermore, if a rider is added, treatment and other dental treatment items, benefits, and insurance premiums are also decided for the rider.

[0048] In step S104, the operator creates a mutual aid clause (a mutual aid contract concluded between the dental clinic and the patient) based on the determined coverage. Service information related to the determined coverage and the created mutual aid clause is stored in the storage device 42 in association with the clinic ID and the patient ID. The mutual aid support server 100 acquires the service information from the storage device 42, and based on the acquired service information, the clinic ID, start date, coverage, and mutual aid clause are registered in the service information registration table 404.

[0049] In step S106, the operator creates a mutual aid flyer for explaining the mutual aid to patients based on the created mutual aid clauses.

[0050] In step S108, the provision of mutual aid begins. Next, we will explain the case where a dental clinic provides mutual aid.

[0051] When a dental clinic provides mutual aid, the procedures and processing are carried out in the order of steps S150 to S160, as shown in Fig. 6(b). Of these, information processing is carried out by a computer in steps S150 to S158.

[0052] In step S150, the administrator registers patient information about existing patients in bulk. Patient information about existing patients is stored as a CSV file or the like in the storage device 42. The mutual aid support server 100 acquires the patient information about existing patients from the storage device 42, and based on the acquired patient information, registers the patient ID, name, date of birth, sex, and contact information in the patient information registration table 402.

[0053] In step S152, the dental clinic individually registers patient information about the new patient. The dental clinic logs in to the management screen of the mutual aid support server 100 on the clinic terminal 200 and enters the patient information about the new patient, which is then sent to the mutual aid support server 100. When the mutual aid support server 100 receives the patient information, it registers the patient ID, name, date of birth, gender, and contact information in the patient information registration table 402 based on the received patient information. Registration can be performed each time a new patient appears.

[0054] In step S154, the dental clinic registers the benefit rate for each tooth for each patient based on the underwriting criteria determined by the dental clinic. The dental clinic logs in to the management screen of the mutual aid support server 100 on the clinic terminal 200 and enters tooth information regarding the patient's teeth and benefit rate, and the tooth information is sent to the mutual aid support server 100. When the mutual aid support server 100 receives the tooth information, it registers the patient ID, tooth ID, and benefit rate in the tooth information registration table 408 based on the received tooth information.

[0055] In step S156, the patient creates an account. When the patient reads, for example, a two-dimensional barcode provided by the dental clinic on the patient terminal 300, the patient is connected to the mutual aid support server 100 and an account creation screen is displayed. When the patient inputs information required for account creation (for example, a user ID and password) on the account creation screen on the patient terminal 300, the input information is sent to the mutual aid support server 100. When the mutual aid support server 100 receives the information required for account creation from the patient terminal 300, it issues an account for the patient based on the received information and registers the account information in the patient information registration table 402.

[0056] In step S158, the patient subscribes to the mutual aid contract from his / her own account. The patient logs in to the management screen of the mutual aid support server 100 on the patient terminal 300, inputs the details of the mutual aid coverage (including whether or not special provisions are attached), and applies for subscription. Contract information regarding the mutual aid contract is then sent to the mutual aid support server 100. When the mutual aid support server 100 receives the contract information, it registers the patient ID, subscription date, and coverage details in the contract information registration table 406 based on the received contract information.

[0057] In step S160, a mutual aid contract is initiated. Next, we will explain the case where a patient visits a dental clinic for preventive care and receives benefits.

[0058] FIG. 7 shows the flow when a patient visits a dental clinic for preventive care and receives benefits. When a patient visits a dental clinic for preventive care and receives benefits, the procedures and processing are carried out in the order of steps S200 to S212, as shown in Figure 7. Of these, information processing is carried out by a computer in steps S204 to S210.

[0059] In step S200, the patient undergoes a preventive visit. In step S202, the dental clinic issues a receipt for the preventive visit.

[0060] In step S204, the patient attaches a receipt from his or her account and claims points. The patient logs in to the management screen of the mutual aid support server 100 on the patient terminal 300, attaches a receipt file, and claims benefits related to the preventive hospital visit. Benefit claim information related to the benefit claim is sent to the mutual aid support server 100. When the mutual aid support server 100 receives the benefit claim information, it registers the claim ID, patient ID, clinic ID, claim date, and receipt file in the claim information registration table 410 based on the received benefit claim information.

[0061] Furthermore, when the dental clinic logs in to the management screen of the mutual aid support server 100 on the clinic terminal 200 and inputs performance information regarding the performance of preventive visits, the performance information is sent to the mutual aid support server 100. Based on the performance information, the mutual aid support server 100 registers the claim ID, patient ID, clinic ID, treatment date, and dental treatment details (preventive visits) in the claim information registration table 410.

[0062] In step S206, the dental clinic approves the benefit claim and provides points. The dental clinic terminal 200 receives a notification from the mutual aid support server 100 that the benefit claim should be approved, and when the dental clinic logs in to the management screen of the mutual aid support server 100, the claim details are displayed. When the dental clinic approves the claim details, approval information indicating the approval is sent to the mutual aid support server 100. When the mutual aid support server 100 receives the approval information, it calculates benefit points based on the information in the claim information registration table 410 and the contract information registration table 406. Specifically, the clinic ID, patient ID, and medical treatment details corresponding to the claim ID are obtained from the claim information registration table 410, and the coverage details corresponding to the clinic ID and patient ID are obtained from the contract information registration table 406. Then, the benefit points are calculated by identifying the points corresponding to the medical treatment details from the coverage details. The calculated benefit points are associated with the claim ID, clinic ID, and patient ID and registered in the claim information registration table 410 and the point history information registration table 412.

[0063] In step S208, the patient applies to use points from their own account. If the patient wishes to use points to cover the cost of dental treatment or the purchase of oral care products, the patient applies to the dental clinic at the time of payment. The patient logs in to the management screen of the mutual aid support server 100 on the patient terminal 300 and enters point usage information regarding point usage, which is then sent to the mutual aid support server 100. When the mutual aid support server 100 receives the point usage information, it registers the patient ID, clinic ID, usage date, used points, and points held after usage in the point history information registration table 412 based on the received point usage information.

[0064] In step S210, the dental clinic approves the point use application and discounts the points. The dental clinic logs in to the management screen of the mutual aid support server 100 using the clinic terminal 200 and enters expense claim information related to the claim for dental treatment, etc., and the expense claim information is sent to the mutual aid support server 100. When the mutual aid support server 100 receives the expense claim information, it associates the received expense claim information with the clinic ID and patient ID and stores it in the storage device 42. The dental clinic then receives a notification from the mutual aid support server 100 using the clinic terminal 200 that the point use application should be approved, and when the dental clinic accesses the management screen of the mutual aid support server 100, the application details are displayed. When the dental clinic approves the application details, approval information indicating the approval is sent to the mutual aid support server 100. When the mutual aid support server 100 receives the approval information, it generates expense settlement information based on the expense claim information in the storage device 42 and the information in the point history information registration table 412. If the points used are equal to or greater than the cost, settlement information is generated indicating that the amount the patient must pay is 0 yen. If the points used are less than the cost, the net amount is calculated by subtracting the points used from the cost, and settlement information is generated indicating that the amount the patient must pay is the net amount. However, the points used cannot exceed the points held before use. The settlement information is stored in the memory device 42 in association with the clinic ID and patient ID. The mutual aid support server 100 issues a receipt based on the settlement information, and the clinic terminal 200 prints the receipt and hands it to the patient.

[0065] In step S212, the administrator irregularly checks the contents of the receipt and the time of approval (for example, the number of days that have passed since the claim for payment) to prevent fraud.

[0066] Next, a case where a patient receives treatment at a dental clinic and receives benefits will be explained. FIG. 8 is a diagram showing the flow when a patient receives treatment at a dental clinic and receives benefits.

[0067] When a patient receives treatment at a dental clinic and receives benefits, the procedures and processing are carried out in the order of steps S300 to S318, as shown in Figure 8. Of these, information processing is carried out by a computer in steps S304, S306, and S312 to S316.

[0068] In step S300, the dental clinic determines that the tooth that is the subject of the benefit needs treatment.

[0069] In step S302, the dental clinic creates a treatment plan and obtains the patient's consent for the treatment plan. The consent information regarding the patient's consent may be entered into the clinic terminal 200 or the patient terminal 300 and stored in the storage device 42 by the mutual aid support server 100 in association with the clinic ID and the patient ID.

[0070] In step S304, the dental clinic sends the treatment plan to the operator. Plan information regarding the treatment plan may be entered into the clinic terminal 200 or the patient terminal 300 and stored in the storage device 42 by the mutual aid support server 100 in association with the clinic ID and the patient ID.

[0071] In step S306, the administrator conducts an examination based on the treatment plan and notifies the dental clinic and the patient of the examination results. Information regarding the examination results may be notified from the mutual aid support server 100 to the clinic terminal 200 and the patient terminal 300. Because the administrator conducts an examination in advance based on the treatment plan, the patient can receive a virtual second opinion on the treatment plan without having to go to another dental clinic.

[0072] In step S308, the dental clinic performs treatment on the patient based on the treatment plan. In step S310, the dental clinic issues a receipt for the treatment.

[0073] In step S312, the patient claims benefits from their own account, attaching a receipt. The patient logs in to the management screen of the mutual aid support server 100 on the patient terminal 300, attaches a receipt file, and claims benefits related to treatment. Benefit claim information related to the benefit claim is sent to the mutual aid support server 100. When the mutual aid support server 100 receives the benefit claim information, it registers the claim ID, patient ID, clinic ID, claim date, and receipt file in the claim information registration table 410 based on the received benefit claim information.

[0074] Furthermore, when the dental clinic logs in to the management screen of the mutual aid support server 100 on the clinic terminal 200 and inputs performance information regarding the performance of treatment, the performance information is sent to the mutual aid support server 100. Based on the performance information, the mutual aid support server 100 registers the claim ID, patient ID, clinic ID, treatment date, tooth ID, and dental treatment details (treatment) in the claim information registration table 410.

[0075] In step S314, the dental clinic approves the benefit claim and pays the benefit. The clinic terminal 200 receives a notification from the mutual aid support server 100 that the benefit claim should be approved, and when the dental clinic logs in to the management screen of the mutual aid support server 100, the claim details are displayed. When the dental clinic approves the claim details, approval information indicating the approval is sent to the mutual aid support server 100. When the mutual aid support server 100 receives the approval information, the benefit is calculated based on the information in the claim information registration table 410, the contract information registration table 406, and the tooth information registration table 408. Specifically, the clinic ID, patient ID, tooth ID, and treatment details corresponding to the claim ID are obtained from the claim information registration table 410, the coverage details corresponding to the clinic ID and patient ID are obtained from the contract information registration table 406, and the benefit rate corresponding to the patient ID and tooth ID is obtained from the tooth information registration table 408. Then, the benefit (full amount) corresponding to the medical treatment content among the coverage details is identified, and the benefit amount is calculated by multiplying the benefit (full amount) by the benefit rate. The calculated benefit amount is associated with the claim ID, clinic ID, patient ID, and tooth ID and registered in the claim information registration table 410.

[0076] In step S316, the administrator transfers the benefit to the patient's account. In step S318, the administrator irregularly checks the contents of the receipt and the time of approval (for example, the number of days that have passed since the claim for payment) to prevent fraud.

[0077] Next, the effects of this embodiment will be described. In this embodiment, the mutual aid support server 100 registers, for each dental clinic, contract information regarding the mutual aid contract in the storage device 42 in correspondence with the clinic ID and patient ID, and registers, in the storage device 42, benefit claim information regarding the claim for benefits and performance information regarding the performance of dental treatment in correspondence with the clinic ID and patient ID, and generates benefit information regarding benefit points or benefits for the dental clinic and patient related to the benefit claim based on the contract information, benefit claim information and performance information in the storage device 42.

[0078] This will allow dental clinics to increase their mutual aid premium income if the extent or frequency of treatment for patients decreases, thereby providing dental clinics with greater incentives to provide preventive dentistry to patients than before.

[0079] Furthermore, in this embodiment, the mutual aid support server 100 registers dental information regarding the teeth that are the subject of benefits in the storage device 42 in association with the clinic ID and patient ID, registers performance information regarding the results of treatment received for the teeth that are the subject of benefits in association with the clinic ID and patient ID in the storage device 42, and generates benefit information regarding benefits for the dental clinic and patient related to the benefit claim based on the contract information, dental information, benefit claim information, and performance information in the storage device 42.

[0080] This allows dental clinics, who are familiar with the condition of their patients' teeth, to control their mutual aid risk by determining whether or not mutual aid coverage is available for each tooth. Even patients with high mutual aid risk (e.g., patients who already have cavities, or patients who would normally require tooth extraction but wish to keep their teeth) can enroll in mutual aid by setting the applicable or unapplicable level for each tooth. Conversely, the method used in the insurance industry to determine whether or not to enroll in mutual aid using disclosure forms (self-reported medical history, hospitalization history, etc.) does not provide accurate risk information, so clinics are forced to determine that patients with high mutual aid risk are "ineligible for enrollment." Alternatively, clinics may underwrite mutual aid for patients with high mutual aid risk, worsening the soundness of the mutual aid system. By setting the applicable or unapplicable level for each tooth, clinics can underwrite mutual aid plans, such as "this tooth cannot be enrolled, but other teeth can," allowing more patients to enroll.

[0081] Furthermore, in this embodiment, billing information regarding the billing of fees for dental treatment, etc. is registered in the memory device 42 in correspondence with the clinic ID and patient ID, and point usage information regarding the use of points is registered in correspondence with the clinic ID and patient ID in the memory device 42, and settlement information for the fees for the dental clinic and patient related to the billing is generated based on the billing information and point usage information in the memory device 42.

[0082] This allows benefits to be received as points and used for dental treatment at dental clinics, etc., making it possible to seamlessly process claims, benefits, and usage related to the contract. Petty claims (claims that occur frequently but with small benefit amounts) are difficult to commercialize as insurance products. The reason is that the high number of claims increases the administrative burden, but no commensurate income from mutual aid premiums can be expected. In this embodiment, benefits are provided for preventive dental visits to give insured persons an incentive to engage in preventive dentistry, which is exactly what a petty claim is. Therefore, by providing and using points instead of cash, the administrative burden can be reduced, thereby making it possible to both respond to petty claims and secure mutual aid premium income.

[0083] In this embodiment, step S104 corresponds to the contract information registration means of invention 1, steps S204 and S312 correspond to the benefit claim information registration means of invention 1, steps S206 and S314 correspond to the benefit information generation means of invention 1, and step S208 corresponds to the point usage information registration means of invention 3. Also, step S210 corresponds to the expense claim information registration means of invention 3 or the settlement information generation means of invention 3, memory device 42 corresponds to the memory means of invention 1 or 3, the clinic ID corresponds to the insurer information of invention 1 or 3, and the patient ID corresponds to the insured person information of invention 1 or 3.

[0084] In this embodiment, the payment points and payment amount calculated in steps S206 and S314 correspond to the payment information of invention 1 or 3.

[0085] [Modification] In the above embodiment and its modifications, registration in tables 400 to 412 can be performed by an operator.

[0086] Furthermore, in the above embodiment and its variations, the mutual aid support server 100 acquires information from the storage device 42, but this is not limited thereto, and the information can be received from the clinic terminal 200 or the patient terminal 300. Furthermore, the mutual aid support server 100 receives information from the clinic terminal 200, but this is not limited thereto, and the information can be acquired from the storage device 42 or received from the patient terminal 300. Furthermore, the mutual aid support server 100 receives information from the patient terminal 300, but this is not limited thereto, and the information can be acquired from the storage device 42 or received from the clinic terminal 200.

[0087] Furthermore, in the above embodiment and its modified examples, points are provided as a benefit for preventive visits, but this is not limited to this, and a benefit can also be provided. Furthermore, a benefit is provided as a benefit for treatment, but this is not limited to this, and points can also be provided. In other words, it can be set freely whether to provide points or a benefit, or both, for dental treatment. The dental treatment to be provided as a benefit can also be set freely.

[0088] In the above embodiment and its variations, the mutual aid is configured as a mutual aid that provides benefits to the insured person according to the performance of dental treatment received by the insured person from the insurer, but it is not limited to this, and can be configured as a mutual aid that provides benefits according to the performance of dental treatment received by the insured person from a dental clinic approved by the insurer, or according to the performance of dental treatment received by the insured person from the insurer and dental clinic approved by the insurer. In this case, information regarding the performance of dental treatment received by the insured person from a dental clinic approved by the insurer is registered in the claim information registration table 410.

[0089] Furthermore, in the above embodiment and its variations, the payment points are calculated in step S206, but this is not limiting and any calculation method can be adopted. For example, payment points (full amount) can be set for each medical treatment, and the payment points corresponding to the medical treatment can be multiplied by the payment rate to calculate the payment. Similarly, the payment amount is calculated in step S314, but this is not limiting and any calculation method can be adopted. For example, one or more dental treatments eligible for payment can be set, and the payment amount can be calculated when the medical treatment falls under one of these. Alternatively, all payment for dental treatments eligible for payment can be made in points, or all payment can be made in cash.

[0090] In the above embodiment and its variations, the mutual aid support server 100 is realized as a single device, but this is not limiting, and some functions may be configured by a separate server, etc. Also, some or all of the mutual aid support server 100 may be configured as a virtual server on a server that provides cloud computing services.

[0091] Furthermore, in the above embodiment and its variations, the mutual aid support server 100 is configured to use the storage device 42, but this is not limiting and it can also be configured to use an external storage device such as a database server.

[0092] Furthermore, in the above embodiment and its modifications, the case where the present invention is applied to a network system consisting of the Internet 199 has been described, but the present invention is not limited to this, and may be applied, for example, to a so-called intranet that communicates using the same method as the Internet 199. Of course, the present invention is not limited to a network that communicates using the same method as the Internet 199, and may be applied to a network of any communication method.

[0093] Furthermore, in the above-described embodiment and its variants, the case where a program pre-stored in ROM 32 is executed when performing information processing has been described, but this is not limited to this. The program showing these procedures may be read into RAM 34 from a storage medium on which the program is stored and executed.

[0094] Here, storage media refers to semiconductor storage media such as RAM and ROM, magnetic storage media such as FD and HD, optically readable storage media such as CD, CDV, LD and DVD, and magnetic storage / optically readable storage media such as MO, and includes all storage media that can be read by a computer, regardless of the reading method (electronic, magnetic, optical, etc.).

[0095] Furthermore, the above-described embodiments and their modifications can be applied to each other. Furthermore, the present invention is not limited to the above-described embodiment and its modifications, and may be applied to other cases within the scope of the gist of the present invention. For example, the present invention may be applied to cases where an insurance contract is made in the narrow sense, rather than a mutual aid contract. [Explanation of symbols]

[0096] 100... Mutual aid support server, 30... CPU, 32... ROM, 34... RAM, 38... I / F, 40... input device, 42... storage device, 44... display device, 199... Internet, 200... clinic terminal, 300... patient terminal, 400... dental clinic information registration table, 402... patient information registration table, 404... service information registration table, 406... contract information registration table, 408... tooth information registration table, 410... billing information registration table, 412... point history information registration table

Claims

1. An insurance support system that supports insurance underwriting, a contract information registration means for registering, for each of a plurality of dental clinics, contract information relating to an insurance contract in which the dental clinic is the insurer and the patient visiting the dental clinic is the insured, and the insured pays benefits according to the performance of dental treatment received by the insurer or a dental clinic approved by the insurer, in a storage means in association with insurer information relating to the insurer and insured person information relating to the insured person; a benefit claim information registration means for registering in the storage means benefit claim information relating to a claim for benefits related to the insurance contract and performance information relating to the performance of dental treatments received by the insurer related to the claim or by a dental clinic approved by the insurer, in association with insurer information relating to the insured person and insured person information relating to the insured person; An insurance support system characterized by comprising a benefit information generation means for generating benefit information regarding benefits related to the insurance contract for the insurer and insured related to the benefit claim based on the contract information, benefit claim information and actual performance information in the storage means.

2. In claim 1, The contract information includes insured tooth information regarding which teeth of the insured person are eligible for benefits and whether or not benefits are available or the extent of benefits, The insurance support system is characterized in that the performance information is performance information regarding the performance of treatment that the insured person received from the insurer for the teeth that are the subject of the benefit.

3. In any one of claims 1 and 2, The benefit information is point information relating to points, an expense claim information registration means for registering in the storage means expense claim information relating to the expense claims made by the insurer to the insured person in association with insurer information relating to the insurer and insured person information relating to the insured person; a point use information registration means for registering point use information relating to the use of said points in said storage means in association with insurer information relating to the insurer who is the point recipient and insured person information relating to the insured person who applies for the use of said points; An insurance support system characterized by having a settlement information generation means for generating settlement information for the expenses for the insurer and insured person related to the expense claim based on the expense claim information and point usage information in the storage means.

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