Incentive granting system, incentive granting device, and incentive granting method

Abstract

To provide an incentive application system which can motivate an insured person and dependent of a health insurance society to behave in a manner of suppressing national medical costs, through application of incentive.SOLUTION: An incentive application system comprises: a condition determination part 15 for determining whether an incentive application condition is satisfied, on the basis of a combination of receipt information which indicates medical care compensation request to an insured person of a health insurance society, and medical product purchase information which indicates a purchase condition of an OTC medical product of an insured person, and vital measurement information of an insured person or medical examination condition information which indicates having a medical examination of an insured person; and an incentive application part 16 for applying an incentive to an insured person or to a health insurance society, when it is determined that the condition is satisfied. Through an incentive applied in medical care which an insured person has in a medical institution or in purchase of an OTC medical product, it is possible to motivate to behave in a manner of suppressing national medical costs.SELECTED DRAWING: Figure 2

Description

[Technical Field]

[0001] The present invention relates to an incentive granting system, an incentive granting device, and an incentive granting method, and is particularly suitable for use in a system that grants incentives related to medical support. [Background technology]

[0002] In recent years, national medical expenses have been increasing due to various factors, such as the aging of the population, an increase in patients with chronic diseases such as cancer and lifestyle-related diseases (diabetes, hypertension, etc.), and soaring drug prices. Effective measures to curb the increase in national medical expenses include using prescription drugs correctly, using generic drugs, undergoing regular health checkups, and engaging in self-medication (including the use of over-the-counter drugs that can be purchased without a prescription at pharmacies, drug stores, and drugstores) by treating minor physical ailments yourself.

[0003] In response to this, systems have been proposed that aim to promote the use of generic drugs by awarding points to patients, hospitals, or pharmacies when they use generic drugs (see, for example, Patent Documents 1 and 2). The system described in Patent Document 1 determines, based on prescription information and drug information, that points are eligible for awarding when the drug being used is a generic drug, and awards points to patients, hospitals, and / or pharmacies identified based on table information according to their usage history of the drug. The system described in Patent Document 2 awards points to insured persons or dependents who switch from new drugs to generic drugs according to the difference in drug price.

[0004] There is also a known system that encourages patients undergoing treatment to use health service providers that can improve their condition by awarding points to them based on points awarding conditions based on information such as medical history, medication history, and medical examination data (see, for example, Patent Document 3). [Prior art documents] [Patent documents]

[0005] [Patent Document 1] Japanese Patent Application Laid-Open No. 2007-108849 [Patent Document 2] Patent No. 5220228 [Patent Document 3] Japanese Patent Publication No. 2005-11051 Summary of the Invention [Problem to be solved by the invention]

[0006] The present invention aims to motivate insured persons and dependents of health insurance associations to take actions that will lead to the reduction of national medical expenses through the provision of incentives. [Means for solving the problem]

[0007] In order to solve the above-mentioned problems, the present invention determines whether or not the incentive granting conditions are met based on a combination of prescription information showing medical fee claims for insured persons from a health insurance association and drug purchase information showing the purchase status of OTC drugs by the insured person, vital sign measurement information of the insured person, or health checkup status information showing the status of health checkups taken by the insured person, and if it is determined that the conditions are met, an incentive is granted to the health insurance association or the insured person. [Effects of the Invention]

[0008] According to the present invention configured as described above, by providing incentives to insured persons of a health insurance association regarding medical treatment received at medical institutions and purchase of OTC drugs, it is possible to motivate insured persons to take actions that will lead to the reduction of national medical expenses. [Brief explanation of the drawings]

[0009] [Figure 1]1 is a diagram illustrating an example of the configuration of an incentive granting system according to an embodiment of the present invention. [Figure 2] 2 is a block diagram showing an example of the functional configuration of a server device (incentive granting device) according to the present embodiment. FIG. [Figure 3] 4 is a flowchart showing an example of the operation of the server device (incentive granting device) according to the present embodiment. DETAILED DESCRIPTION OF THE INVENTION

[0010] An embodiment of the present invention will be described below with reference to the drawings. Fig. 1 is a diagram showing an example of the configuration of an incentive granting system 10 according to this embodiment. As shown in Fig. 1, the incentive granting system 10 of this embodiment is configured to include a server device 1, a combination terminal 2, and a target person terminal 3. The server device 1, the combination terminal 2, and the target person terminal 3 are connected via a communication network 5 such as the Internet and / or a mobile phone network.

[0011] Server device 1 corresponds to an incentive granting device, and executes processing related to granting incentives to a health insurance association or insured persons based on information acquired from association terminal 2 and insured person terminal 3. Details of this processing will be described later using Figure 2. Note that insured persons are insured persons (members) of a health insurance association and their dependents.

[0012] The association terminal 2 is a terminal used, for example, in the health insurance association secretariat, and is configured, for example, by a personal computer. The association terminal 2 may be a server device installed in the health insurance association secretariat or externally. The association terminal 2 provides the server device 1 with information used for the incentive granting process in the server device 1. The information provided from the association terminal 2 to the server device 1 includes receipt information showing medical fee claims for insured persons of the health insurance association and health checkup status information showing the health checkup attendance status of the insured persons.

[0013] A health insurance association using association terminal 2 obtains medical receipt information for insured persons compiled by the health insurance association from medical institutions (including insurance pharmacies) 101 via an examination and payment agency 102. A medical receipt is a medical fee statement submitted by a medical institution to an insured person. Medical fees are fees paid by an insured person to a medical institution in exchange for medical procedures such as examinations, treatment, and prescriptions. Receipt information includes information that can identify the insured person, the date of treatment, the number of treatments, the medical points, and other information for understanding the insured medical expenses based on the medical fees and when they were incurred.

[0014] The health insurance society also obtains health checkup status information of insured persons, which is compiled by the health insurance society, from the health checkup center 103. The health checkup status information includes information that can identify the insured person, the date of the health checkup, the diagnosis of the health checkup results, etc. The information indicating the diagnosis content includes not only the test values ​​for each test item but also an overall assessment rank of the diagnosis results. The overall assessment rank is set, for example, as follows: A: Normal findings (no abnormalities), B: Almost normal (mild abnormal findings), C: Requires follow-up, D: Requires re-examination, E: Requires detailed examination, F: Requires treatment or continued treatment

[0015] The health insurance association stores and manages in a database the medical receipt information obtained from medical institutions 101 via examination and payment agency 102 and the medical checkup status information obtained from medical checkup center 103. Association terminal 2 provides the medical receipt information and medical checkup status information stored in the database to server device 1. Here, association terminal 2 may provide the information to server device 1 in response to a data acquisition request received from server device 1, or may provide the information from association terminal 2 to server device 1 periodically as a batch process. Alternatively, health insurance association staff may operate association terminal 2 to provide the information to server device 1.

[0016] The insured person terminal 3 is a terminal used by the insured person, and is configured, for example, as a smartphone, tablet, personal computer, etc. The insured person terminal 3 provides the server device 1 with information used for the incentive granting process in the server device 1. The information provided from the insured person terminal 3 to the server device 1 includes drug purchase information indicating the insured person's purchase status of OTC drugs and vital sign measurement information of the insured person. Both the drug purchase information and the vital sign measurement information include information that can identify the insured person.

[0017] OTC drugs are not prescription drugs prescribed by a doctor, but are drugs that the insured person can select and purchase themselves at a pharmacy or drugstore. A medicine notebook app is installed on the insured person's terminal 3. The medicine notebook app has a function for inputting and managing information on prescription drugs prescribed by medical institutions and OTC drugs purchased by the insured person. For example, the medicine notebook app has a function for recording drug purchase history and medication history. The insured person's terminal 3 provides the server device 1 with drug purchase information indicating the purchase status of OTC drugs based on the drug purchase history recorded by the medicine notebook app. The drug purchase information includes information that can identify the insured person, and information on the purchase date and purchase amount of the OTC drug.

[0018] The medicine notebook app also has a function for inputting and managing information on the insured person's daily vital signs. Vital signs include at least one of blood pressure and blood glucose levels measured by the insured person themselves, various test item values ​​measured during health checkups including specific health checkups, and various test item values ​​measured when the insured person receives treatment at a medical institution. The vital signs measured by the insured person themselves are called PHR (Personal Health Record) data and are measured using measuring devices in the home or wearable devices. The insured person's terminal 3 provides the server device 1 with the vital sign measurement information of the insured person recorded by the medicine notebook app. The vital sign measurement information includes information that can identify the insured person, the date of vital sign measurement, and measurement value information.

[0019] Here, the subject terminal 3 provides information to the server device 1 in response to, for example, an operation by the insured person on an information registration screen provided by the medicine notebook app. Alternatively, the subject terminal 3 may provide information from the medicine notebook app to the server device 1 periodically as a batch process or non-periodically when triggered by a predetermined state (an example of which will be described later).

[0020] Fig. 2 is a block diagram showing an example of the functional configuration of the server device 1 (incentive granting device) according to this embodiment. As shown in Fig. 2, the server device 1 of this embodiment includes, as its functional configuration, a prescription information acquisition unit 11, a medicine purchase information acquisition unit 12, a vital sign measurement information acquisition unit 13, a medical checkup status information acquisition unit 14, a condition determination unit 15, and an incentive granting unit 16. The server device 1 also includes an acquired information storage unit 17 as a storage medium.

[0021] The functional blocks 11 to 16 execute the following processes through the cooperation of hardware and software. For example, the processes of the functional blocks 11 to 16 are executed by the operation of a program stored in a storage medium such as RAM, ROM, a hard disk, or a semiconductor memory under the control of a processor of a microcomputer including a CPU, RAM, ROM, etc. In addition to the microcomputer, a DSP (Digital Signal Processor) etc. may also be included.

[0022] The medical receipt information acquisition unit 11 acquires medical receipt information from the combination terminal 2 and records it in the acquired information storage unit 17. For example, the medical receipt information acquisition unit 11 acquires medical receipt information from the combination terminal 2 on a monthly basis. For example, the combination terminal 2 transmits medical receipt information for the previous month to the server device 1 on a specified day such as the beginning of the month, and the medical receipt information acquisition unit 11 acquires this information. Note that the acquisition unit and acquisition timing of medical receipt information described here are examples and are not limited to these.

[0023] The drug purchase information acquisition unit 12 acquires drug purchase information from the subject terminal 3 and records it in the acquired information storage unit 17. For example, the drug purchase information acquisition unit 12 acquires drug purchase information from the subject terminal 3 at any timing. For example, when drug purchase information related to OTC drugs is input via the medicine notebook app, the subject terminal 3 transmits the input drug purchase information to the server device 1, and the drug purchase information acquisition unit 12 acquires the information. Note that the acquisition unit and acquisition timing of drug purchase information described here are merely examples and are not limited thereto. For example, like prescription information, the information may be acquired monthly. Also, although an example of acquiring drug purchase information from the subject terminal 3 has been described here, the invention is not limited thereto. For example, drug purchase information related to OTC drugs purchased by the insured person through a health insurance association may be acquired from the association terminal 2.

[0024] The vital sign measurement information acquisition unit 13 acquires vital sign measurement information from the subject terminal 3 and records it in the acquired information storage unit 17. For example, the vital sign measurement information acquisition unit 13 acquires vital sign measurement information from the subject terminal 3 at any timing. For example, the subject terminal 3 transmits the input vital sign measurement information to the server device 1 at the timing when the vital sign measurement information is input via a medicine notebook app, and the vital sign measurement information acquisition unit 13 acquires this information. Note that the acquisition unit and acquisition timing of the vital sign measurement information described here are merely examples and are not limited to these. For example, the vital sign measurement information may be acquired monthly, similar to prescription information.

[0025] The health checkup status information acquisition unit 14 acquires health checkup status information from the combination terminal 2 and records it in the acquired information storage unit 17. For example, the health checkup status information acquisition unit 14 acquires health checkup status information on a monthly basis from the combination terminal 2. For example, the combination terminal 2 transmits the health checkup status information for the previous month to the server device 1 on a predetermined day such as the beginning of the month, and the health checkup status information acquisition unit 14 acquires this information. Note that the acquisition unit and acquisition timing of the health checkup status information described here are merely examples and are not limited to these.

[0026] The condition determination unit 15 determines whether or not predetermined incentive granting conditions are met based on various information stored in the acquired information storage unit 17. For example, the condition determination unit 15 determines whether or not the incentive granting conditions are met based on a combination of medical receipt information and drug purchase information, vital sign measurement information, or health checkup status information. When the condition determination unit 15 determines that the incentive granting conditions are met, the incentive granting unit 16 grants an incentive to the health insurance association or the insured person.

[0027] The incentive granted by the incentive granting unit 16 is arbitrary. For example, points having economic value that can be used in actual commercial transactions may be considered, but are not limited to these. The process of granting an incentive includes a process of registering data corresponding to the incentive in the association terminal 2 or the recipient terminal 3, or a process of notifying the association terminal 2 or the recipient terminal 3 that an incentive will be granted. When an incentive is granted to a health insurance association, the health insurance association distributes the granted incentive to the insured person.

[0028] Specific examples of incentive granting conditions are described below. The condition determination unit 15 determines whether at least one of the incentive granting conditions described below is satisfied. The incentive granting unit 16 grants an incentive to the health insurance association or the insured person when it is determined that at least one of the incentive granting conditions described below is satisfied.

[0029] <Example 1> The condition determination unit 15 determines whether the incentive grant conditions are met for the medical expenses (insured medical expenses, OTC drug purchase amounts) spent by the insured person for a unit period based on the insured person's medical receipt information and drug purchase information (information indicating the purchase status of OTC drugs) stored in the acquired information storage unit 17. The unit period can be set arbitrarily. For example, the unit period can be set to n months (n is any integer).

[0030] The incentive conditions for medical expenses may be, for example, at least one of a first condition that the insured medical expenses for a unit period indicated by the medical receipt information are decreasing compared to the previous period, and a second condition that the amount of OTC drug purchases for a unit period indicated by the drug purchase information are decreasing compared to the previous period. The first condition may be supplemented with a condition that the amount of OTC drug purchases for a unit period is not increasing compared to the previous period. Similarly, the second condition may be supplemented with a condition that the medical expenses for a unit period are not increasing compared to the previous period. For example, the incentive conditions for medical expenses may be that both the first and second conditions are satisfied. Alternatively, the incentive conditions for medical expenses may be supplemented with a condition that the first condition is satisfied and the amount of OTC drug purchases for a unit period is not increasing compared to the previous period.

[0031] Here, the medical expenses for an insured person for a unit period are the total amount of medical expenses for the insured person of the health insurance association and the medical expenses for dependents. If the number of dependents increases or decreases from the previous period to the current period, an adjustment is made, for example, by dividing the total amount by the number of insured persons to determine the average value compared to the previous period. It is also possible to determine the comparison with the previous period using the average total amount regardless of the increase or decrease in the number of dependents.

[0032] The incentive granting unit 16 grants an incentive when the condition determining unit 15 determines that an incentive granting condition related to at least one of the first condition and the second condition is satisfied. For example, the incentive granting unit 16 grants an incentive to an insured person who satisfies at least one of the first condition and the second condition.

[0033] Here, the incentive granting unit 16 may change the size of the incentive to be granted depending on whether it is determined that only the first condition is satisfied, whether it is determined that only the second condition is satisfied, or whether it is determined that both the first and second conditions are satisfied. Furthermore, the incentive granting unit 16 may change the size of the incentive to be granted depending on the degree of reduction in medical expenses compared to the previous period.

[0034] <Example 2> The condition determination unit 15 determines whether or not an incentive grant condition related to the vital signs of the insured person is satisfied based on the vital sign measurement information of the insured person stored in the acquired information storage unit 17. The incentive grant condition related to the vital signs can be, for example, a third condition that the vital signs for a unit period indicated by the vital sign measurement information have improved compared to the previous period. Here, the vital signs for a unit period can be, for example, the worst measurement value, the best measurement value, the average value, or the median value within the unit period.

[0035] The incentive granting unit 16 grants an incentive when the condition determining unit 15 determines that a third condition related to the vital signs is satisfied. For example, the incentive granting unit 16 grants an incentive to an insured person who satisfies the third condition. Here, the incentive granting unit 16 may change the size of the incentive to be granted based on the degree of improvement in the vital signs. For example, the condition determining unit 15 or the incentive granting unit 16 may calculate the percentage improvement in the vital sign measurements compared to the previous period and change the size of the incentive according to that percentage.

[0036] In addition, if the vital signs of an insured person are not bad enough to require treatment, but are showing values ​​that should be taken into consideration in daily life, the insured person's terminal 3 may be sent a message informing them of effective over-the-counter medicines or specific health foods for preventing illness.

[0037] <Example 3> The condition determination unit 15 determines whether or not an incentive granting condition related to the health checkup attendance status of the insured person is satisfied based on the health checkup status information of the insured person stored in the acquired information storage unit 17. The incentive granting condition related to the health checkup attendance status can be, for example, a fourth condition that the diagnosis content of the health checkup results of the insured person indicated by the health checkup status information has improved compared to the previous time or that the diagnosis content remains good. The incentive granting unit 16 grants an incentive when the condition determination unit 15 determines that the fourth condition related to the health checkup attendance status is satisfied. For example, the incentive granting unit 16 grants an incentive to the insured person who satisfies the fourth condition.

[0038] Here, the diagnostic content of the medical checkup result can be, for example, a rank value of the overall judgment specified by a multi-level evaluation. In this case, the condition determination unit 15 checks whether the rank value of the overall judgment at this medical checkup is better than that at the previous medical checkup, and whether the highest rank value (rank A) has continued for a predetermined number of times up to the time of this medical checkup, and if either of these conditions is met, it determines that the fourth condition regarding the medical checkup attendance situation is met. The predetermined number of times can be set arbitrarily.

[0039] The diagnostic content of the health checkup results may be a rank value for each test item, which is determined by a multi-level evaluation. In this case, the condition determination unit 15 checks, for each item, whether the rank value for the current test item has improved compared to the previous test, and determines that the fourth condition regarding the health checkup attendance status is met if a predetermined number or more of the items have improved. Alternatively, the fourth condition may be determined to be met if the percentage of items that have improved is a predetermined percentage or more.

[0040] Alternatively, the measurement value for each test item may be used as the diagnostic content of the health checkup result. In this case, the condition determination unit 15 checks, for example, for each test item, whether the current measurement value has improved compared to the previous one, and determines that the fourth condition regarding the health checkup attendance status is met if there are a predetermined number or more of test items for which the measurement values ​​have improved. Alternatively, the fourth condition may be determined to be met if the percentage of test items for which the measurement values ​​have improved is a predetermined percentage or more.

[0041] Here, the incentive granting unit 16 may change the size of the incentive to be granted depending on the degree of improvement in the diagnostic content compared to the previous time or the degree to which the diagnostic content remains favorable. For example, the size of the incentive to be granted may be changed depending on how much the rank value of the comprehensive assessment has increased compared to the previous time. Alternatively, the size of the incentive to be granted may be changed depending on how many times the highest rank value has continued up to the current medical checkup.

[0042] As another example of an incentive condition related to health checkup attendance status, a fifth condition may be used, which is that the insured person's first health checkup attendance status or continued health checkup attendance status indicated by the health checkup status information meets a predetermined condition. Here, the first health checkup refers to the first health checkup after joining the company (including specific health checkups and gynecological checkups) and the first specific health checkup after turning 40 years old.

[0043] For example, the fifth condition can be a condition that a newly insured person has undergone an initial health checkup (fifth condition 1). Alternatively, the fifth condition can be a condition that the rate at which newly insured people receive an initial health checkup in a unit period is equal to or greater than a predetermined value (fifth condition 2). Furthermore, the fifth condition can be a condition that the number of consecutive health checkups received by an insured person is equal to or greater than a predetermined value (fifth condition 3). Alternatively, the fifth condition can be a condition that the rate at which an insured person continues to receive health checkups equal to or greater than a predetermined number of times is equal to or greater than a predetermined value (fifth condition 4). The predetermined value can be set arbitrarily. For example, the predetermined value can be a target value set by the health insurance association.

[0044] The first health checkup attendance rate is the number of insured persons who underwent their first health checkup in the previous year or the past few years divided by the total number of people who received each health checkup.The health checkup attendance continuation rate is the number of people who are eligible for a second or subsequent health checkup divided by the number of people who actually received the health checkup.The continuation rate may be the continuation rate by number of visits based on the number of visits, the continuation rate by age group based on the age at the time of the most recent health checkup notification, or the continuation rate by gender.

[0045] Here, the condition determination unit 15 is not required to determine all of the fifth conditions 1 to 4, but may determine at least one of them. Note that the fifth conditions 1 and 2 may always be used as a set. Similarly, the fifth conditions 3 and 4 may always be used as a set. When determining any or all of the fifth conditions 1 to 4, the condition determination unit 15 does not necessarily require all of them to be satisfied, and it is possible to determine that the fifth condition is satisfied if any of the multiple conditions is satisfied.

[0046] The incentive granting unit 16 grants an incentive when the condition determining unit 15 determines that the fifth condition is satisfied. For example, the incentive granting unit 16 grants an incentive to an insured person who satisfies the fifth condition 1 or the fifth condition 3. Furthermore, the incentive granting unit 16 grants an incentive to a health insurance association when the fifth condition 2 or the fifth condition 4 is satisfied.

[0047] Furthermore, the incentive granting unit 16 may grant a larger incentive to a dependent among the insured persons when the dependent satisfies the fifth condition than the incentive granted to the insured person when the insured person satisfies the fifth condition. In view of the fact that dependents generally have a lower rate of undergoing health checkups than insured persons, by granting a larger incentive to a dependent when the dependent satisfies the fifth condition, it is possible to effectively motivate dependents with a low rate of undergoing health checkups to undergo health checkups.

[0048] As another example of the incentive granting condition related to the health checkup attendance status, a sixth condition may be used, which is that the medical institution visit status of an insured person indicated by the health checkup status information as needing an examination (hereinafter referred to as a person requiring an examination) satisfies a predetermined condition. For example, the sixth condition may be a condition (sixth condition 1) that the person requiring an examination has visited a medical institution. Alternatively, the sixth condition may be a condition (sixth condition 2) that the medical institution visit rate of the person requiring an examination in a unit period is equal to or greater than a predetermined value. Note that the condition determination unit 15 is not required to determine both sixth conditions 1 and 2, and may determine only one of them. The predetermined value may be set arbitrarily. For example, the predetermined value may be a target value set by the health insurance association.

[0049] Here, a person requiring examination is an insured person who has undergone a health checkup (including a specific health checkup or gynecological checkup), and who has received, for example, a rank D or E out of the rank values ​​A to F in the comprehensive assessment described above. The medical institution visit rate is the value obtained by dividing the total number of people requiring examination in a unit period by the number of people who actually visited a medical institution and underwent an examination. The number of people requiring examination who underwent an examination can be calculated, for example, from medical receipt information obtained from the association terminal 2.

[0050] The incentive granting unit 16 grants an incentive when the condition determining unit 15 determines that the sixth condition is satisfied. For example, the incentive granting unit 16 grants an incentive to an insured person who satisfies the sixth condition 1. Furthermore, the incentive granting unit 16 grants an incentive to a health insurance association when the sixth condition 2 is satisfied.

[0051] As described above, the first to third examples of the incentive granting conditions have been explained, and as mentioned above, the condition determination unit 15 determines whether at least one of these incentive granting conditions is satisfied. When it is determined that at least one of these incentive granting conditions is satisfied, the incentive granting unit 16 grants an incentive to the health insurance association or the insured person.

[0052] For example, it may be possible to determine whether only the incentive granting conditions related to medical expenses (first condition and / or second condition) are satisfied, and to grant an incentive if it is determined that the incentive granting conditions related to medical expenses are satisfied. Alternatively, it may be possible to determine whether an incentive granting condition related to vital signs (third condition) is satisfied in addition to the incentive granting conditions related to medical expenses, and to grant an incentive if it is determined that at least one of the incentive granting conditions related to medical expenses and the incentive granting conditions related to vital signs is satisfied.

[0053] Alternatively, it may be determined whether or not an incentive granting condition related to medical expenses and an incentive granting condition related to health checkup attendance status (at least one of the fourth to sixth conditions) are satisfied in addition to the incentive granting condition related to medical expenses, and an incentive may be granted if it is determined that at least one of the incentive granting condition related to medical expenses and the incentive granting condition related to health checkup attendance status is satisfied. Alternatively, it may be determined whether or not an incentive granting condition related to medical expenses, an incentive granting condition related to vital signs, and an incentive granting condition related to health checkup attendance status is satisfied, and an incentive may be granted if it is determined that at least one of the incentive granting condition related to medical expenses, an incentive granting condition related to vital signs, and an incentive granting condition related to health checkup attendance status is satisfied.

[0054] Fig. 3 is a flowchart showing an example of the operation of the server device 1 according to this embodiment configured as described above. Note that Fig. 3 shows an example of one operation of the process executed by the server device 1, and this operation is executed repeatedly.

[0055] 3, first, the condition determination unit 15 determines whether or not a predetermined timing for executing the incentive granting process has arrived (step S1). The predetermined timing for executing the incentive granting process can be determined arbitrarily. For example, the predetermined timing can be the end of a unit period or the start of the next unit period.

[0056] When the condition determination unit 15 determines that it is time to execute the incentive granting process, it determines whether or not the above-mentioned incentive granting conditions are met based on the various information stored in the acquired information storage unit 17 (step S2). If it is determined that the incentive granting conditions are met, the incentive granting unit 16 grants an incentive to the health insurance association or the insured person (step S3). This ends one round of processing in the flowchart shown in Figure 3. Note that if it is determined in step S1 above that it is not yet time to execute the incentive granting process, or if it is determined in step S2 above that the incentive granting conditions are not met, the process ends one round of processing in the flowchart shown in Figure 3 without doing anything.

[0057] As explained in detail above, in this embodiment, a determination is made as to whether or not the incentive granting conditions are met based on a combination of prescription information showing medical fee claims made to insured persons by a health insurance association and drug purchase information showing the purchase status of OTC drugs by the insured person, vital sign measurement information of the insured person, or health checkup status information showing the status of health checkups taken by the insured person, and if it is determined that the conditions are met, an incentive is granted to the health insurance association or the insured person.

[0058] According to this embodiment configured as described above, by providing incentives to insured persons of a health insurance association when they receive medical treatment at a medical institution or purchase OTC drugs, it is possible to motivate them to take actions that will lead to the reduction of national medical expenses.

[0059] The functions and processes described above can be applied in appropriate combinations. Examples of configurations that can be applied to this embodiment are summarized below.

[0060] [Configuration 1] a condition determination unit that determines whether or not the incentive grant conditions are met based on a combination of receipt information indicating medical fee claims for insured persons from a health insurance association and drug purchase information indicating the purchase status of OTC drugs by the insured persons, vital sign measurement information of the insured persons, or health checkup status information indicating the attendance status of health checkups by the insured persons; an incentive granting unit that grants an incentive to the health insurance association or the insured person when the condition determining unit determines that the incentive granting condition is met. An incentive granting system characterized by:

[0061] [Configuration 2] The incentive granting system described in configuration 1 is characterized in that the condition determination unit determines whether or not the incentive granting conditions regarding the medical expenses spent by the insured person for a unit period are met based on the prescription information and the pharmaceutical purchase information.

[0062] [Configuration 3] The incentive granting system described in configuration 2, wherein the incentive granting conditions related to the medical expenses include at least one of a first condition that the insured medical expenses for the unit period indicated by the prescription information have decreased compared to the previous period, and a second condition that the amount of OTC drug purchases for the unit period indicated by the drug purchase information has decreased compared to the previous period.

[0063] [Configuration 4] 4. The incentive granting system according to configuration 3, wherein the incentive granting unit changes the size of the incentive to be granted depending on the degree of decrease compared to the previous period.

[0064] [Configuration 5] The incentive granting system according to configuration 3 or 4, wherein the conditions for granting incentives related to medical expenses include satisfying both the first condition and the second condition, or satisfying the first condition and not increasing the amount of OTC drug purchases in the unit period compared to the previous period.

[0065] [Configuration 6] The incentive granting system according to any one of configurations 1 to 5, wherein the condition determination unit determines whether or not an incentive granting condition related to the vital signs of the insured person is satisfied based on the vital sign measurement information.

[0066] [Configuration 7] The incentive granting system according to configuration 6, wherein the incentive granting conditions relating to the vital signs include a third condition that the vital signs for a unit period indicated by the vital measurement information have improved compared to the previous period.

[0067] [Configuration 8] 8. The incentive granting system according to configuration 7, wherein the incentive granting unit changes the size of the incentive to be granted depending on the degree of improvement compared to the previous period.

[0068] [Configuration 9] The incentive granting system according to any one of configurations 1 to 8, wherein the condition determination unit determines whether or not the incentive granting conditions regarding the health checkup attendance status of the insured person are met based on the health checkup status information.

[0069] [Configuration 10] The incentive granting system described in configuration 9, characterized in that the incentive granting conditions regarding the health checkup attendance status include a fourth condition that the diagnosis of the health checkup results of the insured person indicated by the health checkup status information has improved compared to the previous time or that good diagnosis results continue.

[0070] [Configuration 11] The incentive granting system according to configuration 10, wherein the fourth condition includes a condition that the diagnostic rank of the health check result has improved from the previous one or that the highest rank has been maintained for a predetermined number of times up to this point.

[0071] [Configuration 12] The incentive granting system according to configuration 10 or 11, wherein the incentive granting unit changes the size of the incentive to be granted depending on the degree of improvement in the diagnostic content compared to the previous time or the degree of continuation of the good diagnostic content.

[0072] [Configuration 13] The incentive granting system according to any one of configurations 9 to 12, wherein the incentive granting conditions relating to the health checkup attendance status include a fifth condition that the insured person's initial health checkup attendance status or continued health checkup attendance status indicated by the health checkup status information satisfies a predetermined condition.

[0073] [Configuration 14] 14. The incentive granting system according to claim 13, wherein the fifth condition includes a condition that the new insured person has undergone an initial medical examination.

[0074] [Configuration 15] The incentive granting system according to configuration 13 or 14, wherein the fifth condition includes a condition that the rate of first health checkup attendance in a unit period of new subscribers who have newly become insured persons is equal to or greater than a predetermined value.

[0075] [Configuration 16] 16. The incentive granting system according to any one of configurations 13 to 15, wherein the fifth condition includes a condition that the number of consecutive medical checkups the insured person has taken is equal to or greater than a predetermined value.

[0076] [Configuration 17] 17. The incentive granting system according to any one of configurations 13 to 16, wherein the fifth condition includes a condition that the rate of the insured person continuing to receive health checkups a predetermined number of times or more is equal to or greater than a predetermined value.

[0077] [Configuration 18] The above insured persons include the insured persons of the above health insurance association and their dependents. The incentive granting unit grants a larger incentive when the dependent satisfies the fifth condition than the incentive granted when the insured satisfies the fifth condition. 18. The incentive granting system according to any one of configurations 13 to 17, wherein:

[0078] [Configuration 19] An incentive granting system according to any one of configurations 9 to 18, wherein the incentive granting conditions relating to the health checkup attendance status include a sixth condition that the medical institution attendance status of the insured person indicated as needing examination by the health checkup status information satisfies a predetermined condition.

[0079] [Configuration 20] 20. The incentive granting system according to claim 19, wherein the sixth condition includes a condition that the insured person who is indicated as needing the examination has visited a medical institution.

[0080] [Configuration 21] The incentive granting system of configuration 19 or 20, wherein the sixth condition includes a condition that the rate of medical institution visits by the insured person indicated as requiring the examination in a unit period is equal to or greater than a predetermined value.

[0081] [Configuration 22] a condition determination unit that determines whether or not the incentive grant conditions are met based on a combination of receipt information indicating medical fee claims for insured persons from a health insurance association and drug purchase information indicating the purchase status of OTC drugs by the insured persons, vital sign measurement information of the insured persons, or health checkup status information indicating the attendance status of health checkups by the insured persons; an incentive granting unit that grants an incentive to the health insurance association or the insured person when the condition determining unit determines that the incentive granting condition is met. 1. An incentive granting device comprising:

[0082] [Configuration 23] A first step in which a condition determination unit of the computer determines whether or not the incentive grant conditions are met based on a combination of receipt information showing medical fee claims for insured persons from a health insurance association and drug purchase information showing the purchase status of OTC drugs by the insured persons, vital sign measurement information of the insured persons, or health checkup status information showing the status of health checkups taken by the insured persons; a second step in which an incentive granting unit of the computer grants an incentive to the health insurance association or the insured person when the condition determining unit determines that the incentive granting condition is satisfied. 1. A method for providing incentives.

[0083] Furthermore, the above-described embodiments are merely examples of specific embodiments for carrying out the present invention, and the technical scope of the present invention should not be construed as being limited thereby. In other words, the present invention can be carried out in various forms without departing from the gist or main characteristics thereof. [Explanation of symbols]

[0084] 1. Server device (incentive granting device) 2. Association terminal 3. Target device 10. Incentive system 11. Receipt Information Acquisition Department 12. Drug Purchasing Information Acquisition Department 13 Vital measurement information acquisition unit 14 Health checkup status information acquisition unit 15 Condition judgment section 16 Incentive Granting Department

Claims

1. a condition determination unit that determines whether or not an incentive grant condition is satisfied regarding the health checkup attendance status of an insured person of a health insurance association, based on health checkup status information indicating the health checkup attendance status of the insured person; an incentive granting unit that grants an incentive to the health insurance association or the insured person when the condition determining unit determines that the incentive granting condition is satisfied; The incentive granting condition regarding the medical checkup attendance status includes a condition that the first medical checkup attendance rate in a unit period of new subscribers who have become the insured persons and are indicated by the medical checkup status information is equal to or greater than a predetermined value. An incentive granting system characterized by:

2. A condition determination unit that determines whether or not an incentive grant condition regarding the health checkup attendance status of an insured person of a health insurance association is met based on health checkup status information that indicates the health checkup attendance status of the insured person of the health insurance association; an incentive granting unit that grants an incentive to the health insurance association or the insured person when the condition determining unit determines that the incentive granting condition is satisfied; The incentive granting condition regarding the health checkup attendance status includes a condition that the rate of the insured person continuing to attend health checkups a predetermined number of times or more, as indicated by the health checkup status information, is equal to or greater than a predetermined value. An incentive granting system characterized by:

3. The above insured persons include the insured persons of the above health insurance association and their dependents. The incentive granting unit grants a larger incentive when the dependent satisfies the incentive granting condition than the incentive granted when the insured satisfies the incentive granting condition.

3. The incentive granting system according to claim 1 or 2.

4. A condition determination unit that determines whether or not an incentive grant condition regarding the health checkup attendance status of an insured person of a health insurance association is met based on health checkup status information that indicates the health checkup attendance status of the insured person of the health insurance association; an incentive granting unit that grants an incentive to the health insurance association or the insured person when the condition determining unit determines that the incentive granting condition is satisfied; The incentive granting condition regarding the medical checkup attendance status includes a condition that the medical examination attendance rate of the insured person, who is indicated as needing an examination by the medical checkup status information, is equal to or greater than a predetermined value during a unit period. An incentive granting system characterized by:

5. a condition determination unit that determines whether or not an incentive grant condition is satisfied regarding the health checkup attendance status of an insured person of a health insurance association, based on health checkup status information indicating the health checkup attendance status of the insured person; an incentive granting unit that grants an incentive to the health insurance association or the insured person when the condition determining unit determines that the incentive granting condition is satisfied; The incentive granting condition regarding the medical checkup attendance status includes a condition that the first medical checkup attendance rate in a unit period of new subscribers who have become the insured persons and are indicated by the medical checkup status information is equal to or greater than a predetermined value.

1. An incentive granting device comprising:

6. A condition determination unit that determines whether or not an incentive grant condition regarding the health checkup attendance status of an insured person of a health insurance association is met based on health checkup status information that indicates the health checkup attendance status of the insured person of the health insurance association; an incentive granting unit that grants an incentive to the health insurance association or the insured person when the condition determining unit determines that the incentive granting condition is satisfied; The incentive granting condition regarding the health checkup attendance status includes a condition that the rate of the insured person continuing to attend health checkups a predetermined number of times or more, as indicated by the health checkup status information, is equal to or greater than a predetermined value.

1. An incentive granting device comprising:

7. The insured persons include the insured persons of the health insurance association and their dependents, The incentive granting unit grants a larger incentive when the dependent satisfies the incentive granting condition than the incentive granted when the insured satisfies the incentive granting condition.

7. The incentive granting device according to claim 5 or 6.

8. A condition determination unit that determines whether or not an incentive grant condition regarding the health checkup attendance status of an insured person of a health insurance association is met based on health checkup status information that indicates the health checkup attendance status of the insured person of the health insurance association; an incentive granting unit that grants an incentive to the health insurance association or the insured person when the condition determining unit determines that the incentive granting condition is satisfied; The incentive granting condition regarding the medical checkup attendance status includes a condition that the medical examination attendance rate of the insured person, who is indicated as needing an examination by the medical checkup status information, is equal to or greater than a predetermined value during a unit period.

1. An incentive granting device comprising:

9. A first step in which a condition determination unit of the computer determines whether or not an incentive grant condition regarding the health checkup attendance status of an insured person of a health insurance association is satisfied based on health checkup status information indicating the health checkup attendance status of the insured person; a second step in which an incentive granting unit of the computer grants an incentive to the health insurance association or the insured person when the condition determining unit determines that the incentive granting condition is satisfied; The incentive granting condition regarding the medical checkup attendance status includes a condition that the first medical checkup attendance rate in a unit period of new subscribers who have become the insured persons and are indicated by the medical checkup status information is equal to or greater than a predetermined value.

1. A method for providing incentives.

10. A first step in which a condition determination unit of the computer determines whether or not the incentive grant conditions regarding the health checkup attendance status of the insured person of the health insurance association are met based on health checkup status information indicating the health checkup attendance status of the insured person; a second step in which an incentive granting unit of the computer grants an incentive to the health insurance association or the insured person when the condition determining unit determines that the incentive granting condition is satisfied; The incentive granting condition regarding the health checkup attendance status includes a condition that the rate of the insured person continuing to attend health checkups a predetermined number of times or more, as indicated by the health checkup status information, is equal to or greater than a predetermined value.

1. A method for providing incentives.

11. The insured persons include the insured persons of the health insurance association and their dependents, The incentive granting unit grants a larger incentive when the dependent satisfies the incentive granting condition than the incentive granted when the insured satisfies the incentive granting condition.

11. The incentive granting method according to claim 9 or 10.

12. A first step in which a condition determination unit of the computer determines whether or not the incentive grant conditions regarding the health checkup attendance status of the insured person of the health insurance association are met based on health checkup status information indicating the health checkup attendance status of the insured person; a second step in which an incentive granting unit of the computer grants an incentive to the health insurance association or the insured person when the condition determining unit determines that the incentive granting condition is satisfied; The incentive granting condition regarding the medical checkup attendance status includes a condition that the medical examination attendance rate of the insured person, who is indicated as needing an examination by the medical checkup status information, is equal to or greater than a predetermined value during a unit period.

1. A method for providing incentives.

Images