Health Management System

Abstract

We will promote the implementation (receiving) of health checkups, reduce medical expenses incurred through health insurance, and ultimately reduce the health insurance premium burden on insured persons. [Solution] The health management system of the present invention is a health management system for insured persons under a health insurance system, and includes a first acquisition means for acquiring the insured person's health examination information from a health examination institution, a first score calculation means for calculating a first score based on the health examination information, a second acquisition means for acquiring the insured person's health insurance usage information from the insurer, a second score calculation means for calculating a second score based on the health insurance usage information, a third score calculation means for calculating a third score based on the first score and the second score, and a benefit determination means for determining, based on the third score, the higher the third score, the more advantageous benefits will be granted to the insured person.

Description

[Technical Field]

[0001] The present invention relates to a health care system. [Background technology]

[0002] Under Japan's universal health insurance system, medical expenses for the government as a whole are steadily increasing, and rising insurance premiums are placing a heavy financial burden on both insurers and insured persons. The finances of all insurance systems, from the National Health Insurance run by local governments such as prefectures and municipalities, to corporate health insurance associations, the National Health Insurance Association, public servant mutual aid associations, and even seamen's insurance, are generally in a tight situation.

[0003] Additionally, currently, health insurers conduct specific health checkups in accordance with the Elderly Medical Care Assurance Act, and employers conduct general health checkups for employees in accordance with Article 66 of the Industrial Safety and Health Act. However, despite the large investments in the health checkup system as a whole, the effectiveness in disease prevention and medical cost containment has been limited, and it is difficult to say that sufficient results have been achieved at present. In order to rationalize medical costs, the Ministry of Health, Labor and Welfare is also considering providing incentives to insurers to promote preventive health, but for example, the implementation rate of specific health checkups in fiscal year 2023 was only 59.7%, suggesting that the current health checkup system makes it difficult for the public to realize its necessity and may not lead to disease prevention or medical cost containment.

[0004] Patent Document 1 relates to a health management system for members of companies, health insurance associations, sports clubs, etc., and describes a health incentive support system that takes into account, in particular, health checkup data, sports club usage, and supplement use, to change members' health awareness and behavior and promote health-consciousness. [Prior art documents] [Patent documents]

[0005] [Patent Document 1] Japanese Patent Publication No. 2022-069818 Summary of the Invention [Problem to be solved by the invention]

[0006] However, although the invention described in Patent Document 1 changes members' health awareness and behavior and promotes a health-conscious attitude, it does not go so far as to establish an effective health checkup system or reduce medical expenses for those using health insurance.

[0007] In light of the current state of Japan's health checkup system, it is urgent to establish an effective health checkup system that contributes to disease prevention and medical cost containment. In other words, an effective health checkup system of the future will require the introduction of a mechanism that will encourage insured persons to undergo health checkups (receive medical examinations) and reduce the incidence of disease, thereby curbing medical expenses incurred through health insurance and ultimately reducing the health insurance premium burden on insured persons.

[0008] The present invention has been proposed in light of the above points, and one of its aims is to promote the implementation (undergoing) of health checkups, reduce medical expenses incurred using health insurance, and ultimately reduce the health insurance premium burden on insured persons. [Means for solving the problem]

[0009] In order to solve the above problems, the health management system of the present invention is a health management system for an insured person under a health insurance system, and includes a first acquisition means for acquiring health examination information of the insured person from a health examination institution, a first score calculation means for calculating a first score based on the health examination information, a second acquisition means for acquiring health insurance usage information of the insured person from an insurer, a second score calculation means for calculating a second score based on the health insurance usage information, a third score calculation means for calculating a third score based on the first score and the second score, and a benefit determination means for determining, based on the third score, the higher the third score, the more advantageous the benefits to be granted to the insured person. [Effects of the Invention]

[0010] According to the embodiment of the present invention, it is possible to promote the implementation (undergoing) of health checkups, reduce medical expenses covered by health insurance, and ultimately reduce the health insurance premium burden on insured persons. [Brief explanation of the drawings]

[0011] [Figure 1] FIG. 1 is a diagram illustrating types of health insurance according to the present embodiment. [Figure 2] 1 is a diagram illustrating an example of a network configuration of a health management system according to an embodiment of the present invention. [Figure 3] FIG. 2 is a diagram illustrating an example of the hardware configuration of a health management server according to the present embodiment. [Figure 4] FIG. 2 is a diagram illustrating an example of the software configuration of a health management system according to the present embodiment. [Figure 5] 2 is a flowchart according to the present embodiment. [Figure 6] FIG. 10 is a diagram showing an example of a health check score table according to the present embodiment. [Figure 7] FIG. 10 is a diagram showing an example of a health insurance utilization score table according to the present embodiment. [Figure 8] FIG. 10 is a diagram showing a benefit calculation table (for employers) according to the present embodiment. [Figure 9] FIG. 10 is a diagram showing a benefit calculation table (for prefectures and municipalities) according to the present embodiment. [Figure 10] FIG. 2 is a diagram showing an example of an insurance premium rate deduction table according to the present embodiment. [Figure 11] FIG. 10 is a diagram summarizing the provision of benefits according to the overall health score according to the present embodiment. [Figure 12] FIG. 10 is a diagram illustrating an example of the software configuration of a health management system according to a modified example. DETAILED DESCRIPTION OF THE INVENTION

[0012] DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS An embodiment of the present invention will be described in detail with reference to the drawings. Figure 1 is a diagram explaining the types of health insurance according to this embodiment. In Japan's health insurance system, the health insurance (insurer) to which the insured person subscribes varies depending on the insured person's "employment type" and "affiliated organization," and the users and the main types of health insurance are as follows:

[0013] ·Workers (and their dependents) employed by small and medium-sized employers and who meet the conditions for joining social insurance are enrolled in the "Kyosai Kenpo" (Association Health Insurance Association). ·Workers (and their dependents (also called dependents)) employed by large corporations and other employers who meet the conditions for joining social insurance are enrolled in a "health insurance association (union health insurance)." Civil servants (and their dependents (also called dependents)) join a mutual aid association. More specifically, national civil servants join the National Civil Servants Mutual Aid Association, and local civil servants join the Local Civil Servants Mutual Aid Association. ·Self-employed freelancers and other individual business owners are required to enroll in National Health Insurance (NHI). ·Unemployed people, retirees, and other unemployed people are enrolled in National Health Insurance (NHI).

[0014] Organizations that operate and manage the health insurance system, such as the National Health Insurance Association (Kenko Ho), health insurance societies, and mutual aid societies, are collectively referred to as "insurers." National health insurance primarily covers self-employed individuals, unemployed individuals, and others who are not covered by employee health insurance, which covers full-time employees, civil servants, and their dependents. Municipalities, as insurers (operating entities), are responsible for the practical aspects of enrolling and withdrawing from the insurance, issuing insurance cards, collecting premiums, and providing benefits. Meanwhile, prefectures, as the entities responsible for financial management, play a managerial role in calculating insurance rates based on forecasts of medical expenses, coordinating financial affairs between municipalities, and stabilizing the system. The national government (Ministry of Health, Labor, and Welfare) is responsible for formulating and supervising the legal framework and standards for the entire system, providing advice and support to prefectures and municipalities.

[0015] In addition to the health insurance mentioned above, for example, private school teachers and staff are covered by the Private School Teachers Mutual Aid Association, seamen as defined by the Shipping Act are covered by Seamen's Insurance, self-employed people in certain industries are covered by the National Health Insurance Association, people aged 75 or over are covered by the Medical Care System for the Elderly, and part-time and casual workers who meet the conditions for joining social insurance (such as working 20 hours or more per week) are covered by the Japan Health Insurance Association or Union Health Insurance, but in this specification we will not explain these in detail in order to make it easier to understand the present invention.

[0016] <System configuration> (Network configuration) Figure 2 is a diagram showing an example of the network configuration of a health management system according to this embodiment. The health management system 100 in Figure 1 includes a health management server 10, a health check DB 20a and computer 20b of a health checkup institution 20, a health insurance usage DB 30a and overall health score DB 30b and computer 30c of an insurer 30, a overall health score DB 40a and computer 40b of an employer 40, and an overall health score DB 41a and computer 41b of a prefecture / city / ward / town / village 41, all of which are connected via a network.

[0017] The health management server 10 is a server device that scores the health condition of the insured person based on the acquired health checkup information (health checkup data) and health insurance usage information (health insurance usage data), and enables the granting of benefits, deduction of points in the insurance premium rate, etc. based on the score. Details will be described later.

[0018] The health checkup institution 20 is an institution that conducts general health checkups or specific health checkups, such as a hospital, clinic, or health checkup center. For example, when each insured person undergoes a health checkup or specific health checkup at the health checkup institution 20 once a year, the health checkup data is stored in the health checkup DB 20a as a record of the health checkup results. Note that the health checkup DB 20a is provided for each actual health checkup institution 20.

[0019] Here, "general health checkups (general health examinations)" include periodic health checkups and employment health examinations administered by employers (businesses) to their workers in accordance with the Industrial Safety and Health Act, and are conducted by companies with the aim of understanding the health status of employees. Meanwhile, "specific health checkups (specific health examinations)" are health checkups implemented by insurers in accordance with the Elderly Medical Care Assurance Act, primarily targeting National Health Insurance and Employee Health Insurance subscribers (dependents) aged 40 to 74, with the aim of preventing lifestyle-related diseases. In other words, general health checkups are structured from "employer to worker," and aim to assess workers' work aptitude and prevent workplace accidents. Meanwhile, specific health checkups are structured from "insurer to insured," and aim to optimize national medical expenses through the early detection of lifestyle-related diseases and the prevention of their worsening.

[0020] The insurer 30 is an organization that provides insurance benefits to insured persons, collects insurance premiums, and operates and manages the health insurance system, such as the Japan Health Insurance Association, health insurance societies, mutual aid societies, and prefectures and municipalities (local governments) that have jurisdiction over national health insurance. For example, when an insured person visits a medical institution (not shown), health insurance utilization data (health insurance utilization information) is stored in the health insurance utilization DB 20b as a medical examination result and record. The health insurance utilization DB 20b is actually provided for each insurer. Note that the insured person visiting a medical institution (not shown) here is different from a general medical examination or specific medical examination at the health examination implementation institution 20, and refers to the insured person receiving insured medical treatment (examination, diagnosis, treatment) at a medical institution as appropriate.

[0021] The employer 40 is the employer of the insured person. The prefecture / city / ward / town / village 41 is the prefecture / city / ward / town / village (local government) where the insured person resides. The comprehensive health score DBs 30b, 40a, and 41a will be described in detail later.

[0022] The network is a communication network, including wired and wireless networks, such as the Internet, public line networks, Wi-Fi (registered trademark), and Bluetooth (registered trademark).

[0023] (Hardware configuration) 3 is a diagram showing an example of the hardware configuration of a health management server according to this embodiment. Health management server 10 includes a central processing unit (CPU) 11, a read-only memory (ROM) 12, a random access memory (RAM) 13, a hard disk drive (HDD) 14, and a communication device 15.

[0024] The CPU 11 executes various programs and performs arithmetic processing. The ROM 12 stores programs required at startup, etc. The RAM 13 is a work area for temporarily storing processing by the CPU 11 and storing data. The HDD 14 stores various data and programs. The communication device 15 communicates with other devices via a network.

[0025] (Software configuration) 4 is a diagram showing an example of the software configuration of the health management system according to this embodiment. Health management server 10 has, as its main functional units, a health checkup data acquisition unit 101, a health checkup score calculation unit 102, a health insurance utilization data acquisition unit 103, a health insurance utilization score calculation unit 104, a total health score calculation unit 105, and a total health score transmission unit 106.

[0026] The medical checkup data acquisition unit 101 has a function of acquiring medical checkup data of the insured person from the medical checkup implementation institution 20 .

[0027] The health check score calculation unit 102 has a function of calculating a health check score based on the health check data.

[0028] The health insurance utilization data acquisition unit 103 has a function of acquiring health insurance utilization data of the insured person from the insurer 30 .

[0029] The health insurance utilization score calculation unit 104 has a function of calculating a health insurance utilization score based on the health insurance utilization data.

[0030] The overall health score calculation unit 105 has a function of calculating an overall health score based on the health check score and the health insurance utilization score.

[0031] The overall health score transmission unit 106 has a function of transmitting the overall health score to the employer 40, the local government 41, and the insurer 30.

[0032] Furthermore, the computer 40b of the employer 40, the computer 41b of the local government 41, and the computer 30c of the insurer 30 each have a total health score receiving unit 107 and a benefit determining unit 108 as their main functional units.

[0033] The overall health score receiving unit 107 has a function of receiving the overall health score from the overall health score transmitting unit 106 .

[0034] The benefit determination unit 108 has a function of determining, based on the overall health score, more advantageous benefits to be given to the insured person as the overall health score increases.

[0035] Each functional unit, including the health management server 10, the computer 40b of the employer 40, the computer 41b of the local government 41, and the computer 30c of the insurer 30, is realized by a program executed on hardware resources such as a CPU, ROM, and RAM. These functional units may also be referred to as "means," "modules," "units," or "circuits." Each DB in the storage unit may also be located in an external storage device on a network. The computer program may also be stored on a computer-readable storage medium.

[0036] <System flow> 5 is a flowchart according to this embodiment. Each step (hereinafter abbreviated as "S") can be realized by the CPU 11 of the health management server 10 reading and executing a program capable of realizing the processing of this flowchart. (Step S1-1) First, the health management server 10 acquires health checkup data as health checkup results and records from the health checkup DB 20a of the health checkup institution 20. Specifically, the health management server 10 can acquire the health checkup data as health checkup results and records from the health checkup DB 20a via an API (Application Programming Interface) or the like.

[0037] The health checkup data may be obtained from the health checkup institution 20 via a storage medium on which the health checkup results and records are recorded. Also, when an insured person who has undergone a general health checkup or a specific health checkup receives the health checkup data from the health checkup institution 20 on his / her own information terminal (for example, a smartphone, tablet terminal, PC, etc.), the insured person can transmit the health checkup data from his / her own information terminal to the health management server 10. Also, if the health checkup data is analog information printed on a paper medium, etc., it can be converted into electronic data and obtained.

[0038] (Step S1-2) When the health management server 10 acquires the health checkup data as the health checkup results and records, it scores the health checkup data for the insured person. As the health checkup data to be used for scoring calculation, if the current year is 2025, the period for scoring calculation of the health checkup data is set based on the health checkup date, for example, from January 1, 2024 to December 31, 2024 of the previous year.

[0039] 6 is a diagram showing an example of a medical checkup score table according to this embodiment. The health management server 10 calculates a medical checkup score (medical checkup health score) based on the medical checkup data of the insured person, for example, in accordance with the medical checkup score table shown in FIG.

[0040] In the health check score table according to this embodiment, "evaluation items," "judgment criteria," and "scores" are predetermined. In the health check data of the insured person, for example, if the "amount of alcohol consumed" is "no alcohol consumed (male or female)," a "score" of 2 is assigned. On the other hand, if the insured person is male and the "amount of alcohol consumed (ethanol) consumed" is "140g or less per week," a "score" of 1 is assigned. If the insured person is female and the "amount of alcohol consumed" is "70g or less per week," a "score" of 1 is assigned. Furthermore, if the "amount of alcohol consumed" is "other than the above" (not applicable to any of the above), a "score" of 0 is assigned.

[0041] For example, if "Smoking History" is "Never smoking," a "Score" of 2 is assigned. On the other hand, if "Smoking History" is "Quit smoking," a "Score" of 1 is assigned. If "Smoking History" is "Currently smoking," a "Score" of 0 is assigned.

[0042] Similarly, the health management server 10 calculates the total score for all the "evaluation items" according to the "criteria" to obtain the health check score for the insured person. In the health check score table shown in Figure 6, the minimum health check score is 0 points and the maximum health check score is 19 points. If health check data cannot be obtained for the insured person (for example, if the insured person has not undergone a health check), the health check score will be 0 points.

[0043] (Step S2-1) The health management server 10 acquires health insurance utilization data as medical examination results and records from the health insurance utilization DB 20b of the insurer 30. Specifically, the health management server 10 can acquire health insurance utilization data as medical examination results and records from the health insurance utilization DB 20b via an API or the like.

[0044] The health insurance utilization data may be obtained from the insurer 30 via a storage medium on which medical results and records are recorded. If the health insurance utilization data is analog information printed on a paper medium, it may be converted into electronic data and obtained.

[0045] (Step S2-2) When the health management server 10 acquires the health insurance utilization data as medical treatment results and records, it scores the health insurance utilization data for the insured person. As the health insurance utilization data to be used for scoring calculation, if the current year is 2025, the period for scoring calculation of the health insurance utilization data is set based on the medical treatment date, for example, from January 1, 2024 to December 31, 2024 of the previous year.

[0046] 7 is a diagram showing an example of a health insurance utilization score table according to this embodiment. The health management server 10 calculates the health insurance utilization score (medical care health score) of the insured person based on the health insurance utilization data of the insured person, for example, in accordance with the health insurance utilization score table shown in FIG.

[0047] In the health insurance utilization score table according to this embodiment, the "evaluation items," "criteria," and "scores" are predefined. For example, if "dental visit" is "yes" in the health insurance utilization data of the insured person, a "score" of 1 is assigned. On the other hand, if "dental visit" is "no," a "score" of 0 is assigned.

[0048] For example, if "oral antihypertensive medication" is listed as "none," a "point" of 2 is assigned. On the other hand, if "oral antihypertensive medication" is listed as "one type," a "point" of 1 is assigned. If "oral antihypertensive medication" is listed as "two or more types," a "point" of 0 is assigned.

[0049] In a similar manner, the health management server 10 calculates the total score for all "evaluation items" according to the "criteria" to obtain a health insurance utilization score. In the health insurance utilization score table shown in Figure 7, the minimum health insurance utilization score is 0 points and the maximum health insurance utilization score is 12 points. If health insurance utilization data cannot be obtained for the insured person (for example, if the insured person has not undergone a health checkup), the health insurance utilization score will be 0 points.

[0050] (Step S3) The health management server 10 adds up the insured person's medical checkup score (medical checkup health score) and the insured person's health insurance utilization score (medical treatment health score) to obtain the insured person's overall health score. In this embodiment, the minimum overall health score is 0 points and the maximum overall health score is 31 points. The health management server 10 obtains the overall health score for each insured person through S1 to S3.

[0051] In addition, the health management server 10 can identify and link the health checkup data of an insured person with the health insurance usage data of the same person by comparing and matching the name, age, address, health insurance card number, and My Number to determine whether the data is of the same person.

[0052] Here, we will discuss the relationship between health checkup scores and health insurance utilization scores. Insured persons make daily efforts to prevent lifestyle-related diseases, detect them early, and prevent them from becoming severe, and as a result of annual health checkups, their health checkup scores will increase. The higher the health checkup score, the lower the disease incidence rate and the healthier the insured person becomes, which means that the insured person will have fewer opportunities to receive insured medical treatment at medical institutions, and their health insurance utilization score will also increase. In other words, health checkup scores are positively correlated with health insurance utilization scores.

[0053] (Step S4) The health management server 10 transmits the overall health score to the "employer" 40 or "prefecture / city / ward / town / village" 41, as well as the "insurer" 30, but this varies depending on the insured person's "employment status" and "affiliated organization" (Figs. 1 and 2).

[0054] If the insured person is employed by an employer and is a worker who meets the conditions for joining social insurance, the comprehensive health score will be sent to the insured person's "employer (company, etc.)" 40 and the "insurer (Kyosai Kenpo or health insurance association)" 30 to which the insured person is enrolled.

[0055] If the insured person is a public servant employed by an employer, the comprehensive health score will be sent to the insured person's "employer (the national government for national public servants, or the local government, etc. for local public servants)" 40 and the "insurer (mutual aid association)" 30 to which the insured person belongs.

[0056] If the insured person is a self-employed person or unemployed (if the insured person does not have an employer), the comprehensive health score is sent to the "prefecture / city / ward / town / village" 41 where the insured person resides and the "insurer (prefecture / city / ward / town / village that has jurisdiction over national health insurance)" 30 to which the insured person is enrolled.

[0057] On the other hand, in the case of dependents (dependents of the insured person who are employed by an employer), the overall health score is sent to the "insurer (Kyosai Kenpo, health insurance association, mutual aid association, etc.)" 30 and the "employer" of the insured person 40.

[0058] Furthermore, because the cost of specific health checkups for dependents is borne by the insurance association to which the employee insurance belongs, the benefits described below are provided by the employee insurance or by the insured person's employer, and the dependents themselves do not pay health insurance premiums directly to the insurer (Kyosai Kenpo or health insurance association) 30. Therefore, in the case of dependents, the overall health score is not sent to the "prefecture, city, ward, town, or village" 41. However, depending on the perspective of sharing the insured person's overall health score and the needs of the system design, the overall health score may also be sent to the "prefecture, city, ward, town, or village" 41 where the dependent resides.

[0059] The overall health scores are received by the computers 40b, 41b, and 30c at the respective destinations via the network and are stored and saved in the respective overall health score DBs 40a, 41a, and 30b (FIG. 1).

[0060] <Benefits awarded according to overall health score> (General health checkup recipients) FIG. 8 is a diagram showing a benefit calculation table (for employers) according to this embodiment. As described above, the overall health score of an insured person who has undergone a general health checkup is first transmitted to the insured person's employer 40 (step S4) and stored in the overall health score DB 40a (FIG. 1). Computer 40b of employer (business owner) 40 refers to the benefit calculation table (FIG. 8(a)) stored in advance in the computer and adds points to the insured person's bonus coefficient (A) according to the insured person's overall health score. The base coefficient of A and the addition coefficient values ​​a, b, c, and d are determined arbitrarily by employer 40. Computer 40b of employer 40 has a program for determining benefits based on the overall health score and the benefit calculation table.

[0061] More specifically, if the employer sets a bonus coefficient calculation table with A=1, a=0.05, b=0.1, c=0.15, and d=0.2, and the insured person's overall health score is 15, the bonus coefficient will be calculated as 1.1 (Figure 8(b)). The insured person's bonus for that year will be calculated by multiplying the company's specified bonus base amount by the bonus coefficient of 1.1, so the insured person will receive a 10% bonus compared to when the overall health score is not reflected.

[0062] The bonus benefit for the insured person is just one example, and the higher the insured person's overall health score, the more advantageous benefits the employer can provide to the insured person. For example, other benefits may include a contribution to salary, gifts, special leave, or a commendation.

[0063] (Special health checkup recipients) FIG. 9 shows benefit calculation tables (for prefectures, municipalities, and insurers) according to this embodiment. As described above, the overall health score of an insured person who has undergone a specific health checkup is first transmitted to the prefecture, municipality 41 where the insured person resides (step S4) and stored in the overall health score DB 41a. The computer 41b of the prefecture, municipality 41 references the benefit calculation table (FIG. 9(a)) stored in advance in the computer and determines the benefits to be granted to the insured person according to the insured person's overall health score.

[0064] In addition, the overall health score of a dependent who has undergone a specific health checkup (a dependent of an insured person who is employed by an employer) is sent to the insurer (such as the Japan Health Insurance Association, a health insurance association, or a mutual aid association) 30 of the insured person (step S4) and stored in the overall health score DB 30c (Fig. 1). The computer 30c of the insurer 30 refers to a benefit calculation table (Fig. 9(a)) stored in advance in the computer and determines the benefit to be granted to the dependent according to the dependent's overall health score.

[0065] The contents of the benefits a, b, c, and d are determined at the discretion of the prefecture / city / ward / town / village 41 or the insurer 30. However, in cases where the funds and costs of the benefits for dependents are borne by the employer (business owner) 40 who employs the insured dependent, rather than the insurer 30, the insurer 30 may decide the contents of the benefits a, b, c, and d in consultation with the employer (business owner) 40. The computer 41b of the prefecture / city / ward / town / village 41 and the computer 30c of the insurer 30 have programs for determining the benefits based on the overall health score and the benefit calculation table.

[0066] More specifically, if a prefecture / city / ward / town / village 41 or an insurer 30 determines a benefit calculation table with a = 1 regional ticket, b = 2 regional tickets, c = 3 regional tickets, and d = 5 regional tickets, and if the insured person's overall health score is 15 points, the granted benefit is determined to be 2 regional tickets (Figure 9(b)). The insured person can obtain the benefit of 2 regional tickets more than if the overall health score was not reflected.

[0067] The regional coupon (shopping coupon) benefits for the insured person and dependents are just one example, and the higher the overall health score of the insured person and dependents, the more advantageous benefits can be given to the insured person and dependents by the prefectures, cities, wards, towns, and villages 41 and the insurers 30.

[0068] (Insurance premiums will be deducted according to your overall health score) Figure 10 is a diagram showing an example of an insurance premium rate deduction table according to this embodiment. As described above, the insured person's overall health score is sent to the insurer 30 to which each insured person belongs (step S4) and stored in the overall health score DB 30b (Figure 1). The "insurers" 30 are the Japan Health Insurance Association, health insurance societies, mutual aid societies, and prefectures, cities, towns, and villages that have jurisdiction over national health insurance (Figures 1 and 2).

[0069] The computer 30c of the "insurer" 30 refers to an insurance premium rate deduction table (Figure 10) stored in advance in the computer and determines the insurance premium rate of the insured person according to the insured person's overall health score. The insurance premium rate E differs for each association and is the insurance premium rate applied by each insurer 30. The deduction values ​​e, f, g, and h are determined arbitrarily by the insurer 30, taking into consideration each association's financial situation, etc. The computer 41b of the "prefecture / city / ward / town / village" 41 has a program for determining the insurance premium rate to be deducted based on the overall health score and the insurance premium rate deduction table.

[0070] FIG. 11 is a diagram summarizing the granting of benefits according to the overall health score in this embodiment. For workers and civil servants, the higher the insured person's overall health score, the more advantageous bonuses they will receive from their employer. In addition, more advantageous insurance rates will be granted and applied by insurers (health insurance societies, Japan Health Insurance Association, and mutual aid societies), reducing the burden (payment) of health insurance premiums.

[0071] For self-employed and unemployed individuals, the higher the insured person's overall health score, the more advantageous regional coupons they will receive from prefectures and municipalities. In addition, more advantageous insurance rates will be granted and applied by the insurer (the prefectures and municipalities that have jurisdiction over the National Health Insurance), reducing the amount of health insurance premiums they will have to pay.

[0072] In the case of dependents (dependents of the insured who are employed by the employer), the higher the dependent's overall health score, the more advantageous regional vouchers will be granted by the insurer.

[0073] <Summary> The health management system 100 according to this embodiment integrates and manages the health checkup data from the health checkup institution 20 and the health insurance usage data from the insurer 30, scores (quantifies) the health status of each insured person, and grants benefits to the insured person according to the score. This motivates the insured person to undergo annual health checkups and continue to receive these benefits. Furthermore, the higher the score, the more advantageous benefits are granted, so more insured persons will be motivated to improve their scores and receive more advantageous benefits next time. As a result, the number of people with high scores increases, the incidence of disease decreases, and individual insured persons become healthier. Furthermore, the healthier individual insured persons are, the less medical expenses they spend. This reduction in medical expenses is expected to reduce the burden on insurance finances, corporate management, and insured persons.

[0074] <Modification> Fig. 12 is a diagram showing an example of the software configuration of a health management system according to this modification. Compared to the software configuration example in Fig. 4, health management server 10 differs in that it has a benefit determination unit 108 and a benefit transmission unit 109. Also, computer 40b of employer 40, computer 41b of prefecture / city / ward / town / village 41, and computer 30c of insurer 30 differ in that they have a benefit reception unit 110.

[0075] That is, in this modified example, the health management server 10 determines the benefit and transmits the determined benefit to the computer 40b of the employer 40, the computer 41b of the prefecture / city / ward / town / village 41, and the computer 30c of the insurer 30. The computer 40b of the employer 40, the computer 41b of the prefecture / city / ward / town / village 41, and the computer 30c of the insurer 30 receive the benefit determined on the health management server 10 side.

[0076] The employer 40, prefectures / municipalities 41, and insurer 30 provide their own determined benefit calculation tables and insurance premium rate deduction tables to the health management server 10 in advance. For example, the personnel of the employer 40, prefectures / municipalities 41, and insurer 30 access a website provided by the health management server 10 from their respective computers and upload their own determined benefit calculation tables and insurance premium rate deduction tables to the health management server 10. Once the benefits are determined on the health management server 10 side, the determined benefits are transmitted from the health management server 10 to each computer. The determined benefits may be displayed on the website.

[0077] In this way, the functional parts of the health management system only need to be present in the entire system, and each functional part, i.e., the health management server 10, the computer 40b of the employer 40, the computer 41b of the prefecture / city / town / village 41, and the computer 30c of the insurer 30, is realized by a program executed on hardware resources such as a CPU, ROM, RAM, etc. Therefore, as long as the system is established, the program may be placed on either the health management server side or the computer side of the employer 40, the prefecture / city / town / village 41, or the insurer 30.

[0078] For example, it is also possible for the health examination institution 20, which has the health examination data, to calculate the health examination score (health examination score calculation unit 102) and send the calculated health examination score to the health management server 10, and for the insurer 30, which has the health insurance utilization data, to calculate the health insurance utilization score (health insurance utilization score calculation unit 104) and send the calculated health insurance utilization score to the health management server 10, which then calculates the overall health score (overall health score calculation unit 105).

[0079] <Supplementary information> The Long-Term Care Insurance System is an independent medical insurance system in Japan for people aged 75 or older (or those aged 65 or older but under 75 who have been certified as having certain disabilities). The insurer (the organization that operates the system) is the Long-Term Care Insurance Association established in each prefecture, and municipalities are responsible for practical matters such as collecting insurance premiums and issuing insurance certificates.

[0080] The financial resources are roughly 50% public funds (national, prefectural, and municipal) and 40% subsidies from the working generation (support from the Japan Health Insurance Association, health insurance societies, national health insurance, etc.), with insurance premiums from insured persons accounting for approximately 10%, which is one of the factors contributing to the tightness of health insurance finances.

[0081] Furthermore, elderly people can receive medical checkups (medical checkups for the elderly) with the costs covered by the Association of Medical Care for the Elderly. That is, the health management system 100 described above can be applied to elderly people as well, and the comprehensive health score is calculated and transmitted to the Association of Medical Care for the Elderly in the prefecture where the elderly person resides, and incentives such as special benefits and reduced insurance premiums are granted.

[0082] This will prevent those who are not yet in need of care from becoming so, and as a result, if the number of people with high scores increases, the elderly (insured persons) will be able to maintain better health. Furthermore, the healthier the elderly are, the less medical expenses they will spend, and if medical expenses decrease, it can be expected that the burden on insurance finances and insured persons will be reduced.

[0083] While the present invention has been described above by showing particular examples according to preferred embodiments of the present invention, it will be apparent that various modifications and changes can be made to these examples without departing from the broader spirit and scope of the present invention as defined in the appended claims. In other words, the details of the examples and the accompanying drawings should not be construed as limiting the present invention.

[0084] (Addendum) A health management system for an insured person in a health insurance system (health management system 100 in FIGS. 4 and 12), a first acquisition means (health checkup data acquisition unit 101) for acquiring health checkup information (health checkup data) of the insured person from a health checkup institution; a first score calculation means (health check score calculation unit 102) for calculating a first score (health check score) based on the health check information; a second acquisition unit (health insurance utilization data acquisition unit 103) for acquiring health insurance utilization information (health insurance utilization data) of the insured person from an insurer; a second score calculation unit (health insurance utilization score calculation unit 104) for calculating a second score (health insurance utilization score) based on the health insurance utilization information; a third score calculation means (total health score calculation unit 105) for calculating a third score (total health score) based on the first score and the second score; A benefit determination unit (benefit determination unit 108) that determines, based on the third score, a more advantageous benefit to be granted to the insured person as the third score increases; A health management system comprising: [Explanation of symbols]

[0085] 10 Health Management Server 20 Health examination institutions 20a Health Check DB 30 Insurer 30a Health insurance usage database 40 Employers 41 prefectures, cities, towns and villages 30b, 40a, 41a Comprehensive Health Score DB 100 Health Management System 101 Health Checkup Data Acquisition Department 102 Health check score calculation unit 103 Health Insurance Usage Data Acquisition Department 104 Health Insurance Utilization Score Calculation Department 105 Comprehensive Health Score Calculation Section 106 Comprehensive Health Score Transmission Unit 107 Comprehensive Health Score Receiving Department 108 Benefit Decision Department

Claims

1. A health care management system for insured persons in a health insurance system, a first acquisition means for acquiring health examination information of the insured person from a health examination institution; a first score calculation means for calculating a first score based on the health checkup information; a second acquisition means for acquiring health insurance utilization information of the insured person from an insurer; a second score calculation means for calculating a second score based on the health insurance utilization information; a third score calculation means for calculating a third score based on the first score and the second score; A benefit determination means for determining, based on the third score, a more advantageous benefit to be granted to the insured person as the third score increases; A health management system comprising:

2. and score transmission means for transmitting the third score to the insured person's employer if the insured person has an employer; The benefit is a benefit granted to the insured by the employer; The health management system according to claim 1 .

3. and score transmission means for transmitting the third score to a local government in which the insured person resides if the insured person does not have an employer; The benefit is a benefit granted to the insured person by the local government; The health management system according to claim 1 .

4. a score transmission means for transmitting the third score to the insurer, The benefit is a benefit that reduces the insurance premium rate applied to the insured person; 4. The health management system according to claim 1, wherein:

5. A health management system including a health management device, an employer computer having an employer program loaded therein, a local government computer having a local government program loaded therein, and an insurer computer having an insurer program loaded therein, The health management device a first acquisition means for acquiring health examination information of the insured person from a health examination institution; a first score calculation means for calculating a first score based on the health checkup information; a second acquisition means for acquiring health insurance utilization information of the insured person from an insurer; a second score calculation means for calculating a second score based on the health insurance utilization information; a third score calculation means for calculating a third score based on the first score and the second score; a score transmission means for transmitting the third score to a computer of the insured person's employer if the insured person has an employer, to a computer of the local government where the insured person resides if the insured person does not have an employer, and to a computer of the insurer; Employer programs include: Your employer's computer and functioning as a benefit determination means for determining, based on the third score, a more advantageous benefit to be granted to the insured person as the third score is higher; The local government program Local government computers, and functioning as a benefit determination means for determining, based on the third score, a more advantageous benefit to be granted to the insured person as the third score is higher; The insurer program The insurer's computer, The system functions as a benefit determination means for determining a benefit in which the higher the third score, the more the insurance premium rate applied to the insured person is reduced. A health management system characterized by:

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