Private medical treatment price calculation device

Abstract

To make it possible to present a well-balanced self-funded medical treatment price for both a medical institution and a patient.SOLUTION: A self-funded medical treatment price calculation device includes: a medical institution-side information acquisition unit 11 that acquires medical institution-side load determination information that serves as a basis for estimating a load state on medical treatment at the medical institution; a patient-side information acquisition unit 12 that acquires patient-side load determination information that serves as a basis for estimating a physical or mental load state of a patient; and a price calculation unit 13 that calculates a self-funded medical treatment price based on the medical institution-side load determination information and the patient-side load determination information. By calculating the self-funded medical treatment price that reflects the load states of both the medical institution and the patient, it is possible to present the well-balanced self-funded medical treatment price for both the medical institution and the patient.SELECTED DRAWING: Figure 2

Description

[Technical Field]

[0001] The present invention relates to an apparatus for calculating the price of elective medical treatment, and is particularly suitable for use in an apparatus for calculating the price of elective medical treatment that is received without using health insurance or the like. [Background technology]

[0002] As is well known, medical institutions offer two types of medical treatment: insured medical treatment and non-insured medical treatment. Insured medical treatment is medical treatment stipulated by the National Health Insurance Act and the Health Insurance Act, and typically 70% of medical expenses are covered by the National Health Insurance or health insurance association, with the remaining 30% being paid by the patient. On the other hand, non-insured medical treatment is medical treatment received without using health insurance, and all medical expenses incurred are borne by the patient. Medical institutions are free to decide the amount of non-insured medical treatment.

[0003] The advantage of using private medical care for patients is that they have more treatment options (including treatments not approved in Japan) and can receive treatment that is suited to their constitution and illness. However, the disadvantage is that medical costs can be high. Although the price of private medical care is determined based on an individual contract between the patient and the medical institution, the price quoted by the medical institution is often high, which places a heavy financial burden on the patient. As a result, even if patients want private medical care, they often cannot receive it.

[0004] The advantage of medical institutions offering elective medical care is that they can expect to increase sales compared to only providing insured medical care. However, as mentioned above, elective medical care places a heavy financial burden on patients, so in reality, elective medical care is not offered very often. In addition, because elective medical care is provided among many other insured medical care, it is necessary to properly manage the schedules of medical staff and the preparation of dedicated equipment, which can be a burden for medical institutions.

[0005] A medical system is known that can roughly estimate hospital revenues and patient copayments, making it easy to understand the cost benefits in terms of medical fees, optimizing drug costs, hospital management, and patient copayments (see, for example, Patent Document 1). The medical system described in Patent Document 1 performs the following processes: outputting the standard medical fees and patient copayments for the selected optimal treatment method; outputting the standard upper limit for the drug cost portion related to the medical fees; and outputting drugs that can be prescribed within the standard upper limit for the drug cost portion, particularly generic drugs, and the patient's copayment for those drugs. However, this system optimizes medical fees for insured medical treatment, and does not determine the prices for non-insured medical treatment. [Prior art documents] [Patent documents]

[0006] [Patent Document 1] Japanese Patent Application Laid-Open No. 2002-251458 Summary of the Invention [Problem to be solved by the invention]

[0007] The present invention has been made to solve such problems, and aims to make it possible to present a balanced private medical treatment price to both medical institutions and patients. [Means for solving the problem]

[0008] In order to solve the above-mentioned problems, the present invention calculates the elective medical treatment price based on information for determining the medical institution's load, which serves as the basis for estimating the medical institution's load on medical treatment, and information for determining the patient's load, which serves as the basis for estimating the patient's physical or mental load. [Effects of the Invention]

[0009] According to the present invention configured as described above, an elective medical treatment price is calculated that reflects the burden on both the medical institution and the patient, making it possible to present an elective medical treatment price that is balanced for both the medical institution and the patient. [Brief explanation of the drawings]

[0010] [Figure 1] 1 is a diagram showing an example of the overall configuration of an elective medical treatment price calculation system equipped with an elective medical treatment price calculation device according to this embodiment. [Figure 2] 1 is a block diagram showing an example of the functional configuration of an elective medical treatment price calculation device according to an embodiment of the present invention; [Figure 3] FIG. 10 is a diagram showing an example of table information for determining whether to raise or lower the elective medical treatment price based on operating status information. [Figure 4] FIG. 10 is a diagram showing an example of table information for determining whether to raise or lower the elective medical treatment price based on vacancy information. [Figure 5] FIG. 10 is a diagram showing an example of table information for determining whether to raise or lower the elective medical treatment price based on weather information. [Figure 6] FIG. 10 is a diagram showing an example of table information for determining whether to raise or lower the price of elective medical treatment based on traffic information. DETAILED DESCRIPTION OF THE INVENTION

[0011] An embodiment of the present invention will be described below with reference to the drawings. Figure 1 is a diagram showing an example of the overall configuration of an elective medical treatment price calculation system equipped with an elective medical treatment price calculation device according to this embodiment. As shown in Figure 1, the elective medical treatment price calculation system of this embodiment is configured to include an elective medical treatment price calculation device 100, a medical staff management system 200, an outpatient management system 300, a weather information providing system 400, and a traffic information providing system 500. The elective medical treatment price calculation device 100 is connected to the medical staff management system 200, the outpatient management system 300, the weather information providing system 400, and the traffic information providing system 500 via a communication network 600 such as the Internet.

[0012] The non-exempt medical treatment price calculation device 100 calculates the price of non-exempt medical treatment. The specific functions of this device will be described later.

[0013] The medical staff management system 200 manages the operating status of doctors, nurses, and other staff working at medical institutions. For example, the medical staff management system 200 manages information such as the attendance and working hours of medical staff, the doctor's medical treatment location (inside or outside the hospital), the doctor's sleeping hours, and the doctor's surgery schedule (hereinafter referred to as operating status information) as daily information. For example, this operating status information is manually entered into the medical staff management system 200 by medical staff. The medical staff management system 200 provides this operating status information to the elective medical treatment price calculation device 100 via the communication network 600.

[0014] The outpatient management system 300 manages information such as outpatient reservations and reception, and the status of medical treatment, as daily information (hereinafter referred to as outpatient management information). The outpatient management system 300 provides this outpatient management information to the elective medical treatment price calculation device 100 via the communication network 600.

[0015] Outpatient appointments can be made online, for example, from a terminal such as a smartphone or personal computer used by the patient. Alternatively, the patient can make an appointment offline by calling the medical institution. When making an appointment online, the patient accesses the appointment screen of the outpatient management system 300 from their terminal via the communication network 600 and enters the appointment date and time, patient name, and other necessary information. When making an appointment offline, the medical professional manually enters the appointment date and time, patient name, and other necessary information obtained from the patient over the phone into the outpatient management system 300. Note that the outpatient appointment method shown here is an example and is not limited to this.

[0016] Outpatient reception can be performed, for example, using a reception system including a number issuing machine installed at the medical institution. Patients can also visit the medical institution and receive treatment without making an appointment. In this case, the patient operates the number issuing machine to issue a number card, and is added to the waiting list. When the outpatient management system 300 detects that a number card has been issued by operating the number issuing machine, it automatically inputs information indicating that the outpatient has been accepted. Note that the outpatient reception method shown here is an example and is not limited to this.

[0017] The medical treatment status is information indicating whether or not the medical treatment has been completed for an outpatient for whom a reservation or reception has been made. For example, the medical professional who performed the medical treatment manually inputs information indicating this into the outpatient management system 300 when the medical treatment has been completed. Alternatively, the medical treatment status management system 300 may be configured to cooperate with an accounting system (not shown) to notify the outpatient management system 300 that the accounting has been completed, and when the completion of the accounting is detected, the outpatient management system 300 may automatically input information indicating that the medical treatment has been completed. Note that the method of managing the medical treatment status shown here is an example and is not limited to this.

[0018] The weather information providing system 400 provides weather information to the general public. For example, the weather information providing system 400 provides weather information published by the Japan Meteorological Agency on a website. The weather information provided by the weather information providing system 400 includes, for example, atmospheric pressure, temperature, humidity, hours of sunshine, precipitation, UV rays, wind speed, rainfall, snowfall, and lightning occurrence. For example, the elective medical treatment price calculation device 100 obtains the above-mentioned weather information from a website published by the weather information providing system 400. Alternatively, the weather information providing system 400 may notify the elective medical treatment price calculation device 100 of the above-mentioned weather information.

[0019] The traffic information providing system 500 provides traffic information to the general public. For example, the traffic information providing system 500 provides the latest road traffic information on a website. The traffic information provided by the traffic information providing system 500 includes, for example, congestion, construction work, traffic accidents, and traffic restrictions (including those due to weather abnormalities, disasters, security, events, crimes, etc.). For example, the elective medical treatment price calculation device 100 acquires the above traffic information from a website made public by the traffic information providing system 500. Alternatively, the traffic information providing system 500 may notify the elective medical treatment price calculation device 100 of the above traffic information.

[0020] 2 is a block diagram showing an example of the functional configuration of the elective medical treatment price calculation device 100 according to this embodiment. As shown in Fig. 2, the elective medical treatment price calculation device 100 according to this embodiment has, as its functional configuration, a medical institution-side information acquisition unit 11, a patient-side information acquisition unit 12, and a price calculation unit 13.

[0021] Each of the functional blocks 11 to 13 can be configured by any of hardware, a DSP (Digital Signal Processor), and software. For example, when configured by software, each of the functional blocks 11 to 13 is actually configured with a CPU, RAM, ROM, etc. of a computer, and is realized by the operation of a program stored in a recording medium such as the RAM, ROM, hard disk, or semiconductor memory.

[0022] The medical institution side information acquisition unit 11 acquires information (hereinafter referred to as medical institution side load determination information) that serves as a basis for estimating the load situation of the medical institution for medical treatment. The medical institution side load determination information is operation status information provided by the medical staff management system 200 and outpatient management information provided by the outpatient management system 300.

[0023] Among the operating status information of medical personnel, working hours are information that makes it possible to estimate the workload of medical personnel based on the length of continuous working hours. The location of medical treatment is information that makes it possible to estimate the workload of medical personnel based on whether the location is inside or outside the hospital. The sleeping hours are information that makes it possible to estimate the workload of medical personnel based on the length of the sleeping hours. The surgery schedule is information that makes it possible to estimate the workload of medical personnel based on, for example, whether or not a highly difficult surgery is scheduled to be performed.

[0024] Among the operational status information of medical staff, attendance information and outpatient management information can be used as occupancy information related to the availability of patients at medical institutions. For example, it is possible to estimate the workload of medical staff based on the number of outpatient appointments and receptions and the number of staff members indicated as on duty by attendance information. In other words, it is possible to estimate that the more outpatients there are, the higher the workload of medical staff, and the fewer staff members there are on duty. Furthermore, the number of patients whose treatment has ended may also be used as occupancy information. For example, the number of patients waiting for treatment may be calculated from the number of outpatient appointments and receptions and the number of patients whose treatment has ended, and this may be used as occupancy information. Furthermore, the lead time until the appointment date and the lead time until the end of business may also be used as occupancy information.

[0025] The patient-side information acquisition unit 12 acquires information (hereinafter referred to as patient-side load determination information) that serves as a basis for estimating the physical or mental load status of the patient. The patient-side load determination information is weather information provided by the weather information providing system 400 and traffic information provided by the traffic information providing system 500.

[0026] Weather information such as atmospheric pressure, temperature, humidity, hours of sunshine, precipitation, UV rays, wind, rainfall, snowfall, and lightning strikes is weather-related information that can affect a patient's symptoms. In particular, for meteorological illnesses, which can cause headaches, swelling, fatigue, dizziness, lethargy, and depression due to weather conditions, weather information can be said to be a factor that affects a patient's symptoms.

[0027] Traffic information, such as traffic congestion, construction work, traffic accidents, and traffic restrictions, is information related to traffic conditions that can be a burden on patients when they go to the hospital. In particular, for diseases that require car travel because it is difficult to use public transportation such as trains, and for which the risk of developing is higher if patients are trapped in a vehicle for long periods of time due to traffic congestion, construction work, traffic accidents, traffic restrictions, etc. (e.g., neurological disorders, psychosomatic disorders, cranial nerve disorders, cardiovascular disorders, etc.), traffic information can be said to be a factor that affects the symptoms of patients.

[0028] The price calculation unit 13 calculates the elective medical treatment price based on the medical institution side load determination information acquired by the medical institution side information acquisition unit 11 and the patient side load determination information acquired by the patient side information acquisition unit 12. Here, the price calculation unit 13 calculates the elective medical treatment price in accordance with the price calculation standards shown in (1) and (2) below. (1) If information for assessing the burden on medical institutions that is the basis for estimating that the burden on medical institutions is high is obtained, the price of elective medical treatment will be increased, and if information for assessing the burden on medical institutions that is the basis for estimating that the burden on medical institutions is low is obtained, the price of elective medical treatment will be decreased. (2) If information for determining patient burden that is the basis for estimating that the patient burden is high is obtained, the price of elective medical treatment will be lowered, and if information for determining patient burden that is the basis for estimating that the patient burden is low is obtained, the price of elective medical treatment will be raised.

[0029] For example, the price calculation unit 13 sets a threshold value for each piece of medical institution load determination information (medical worker operating status information and medical institution vacancy information) that indicates whether the load on the medical institution is high or low, and individually determines whether to raise or lower the elective medical treatment price depending on whether the value indicated by the medical institution load determination information is greater than the threshold value. Similarly, the price calculation unit 13 sets a threshold value for each piece of patient load determination information (weather information and traffic information) that indicates whether the load on the patient is high or low, and individually determines whether to raise or lower the elective medical treatment price depending on whether the value indicated by the patient load determination information is greater than the threshold value. Then, by comprehensively determining the results of the individual determinations for each piece of medical institution load determination information and the results of the individual determinations for each piece of patient load determination information, the unit determines whether to raise or lower the elective medical treatment price and the amount to increase or decrease it relative to a preset reference price.

[0030] 3 to 6 are diagrams showing examples of table information for determining whether to raise or lower the elective medical treatment price for each piece of medical institution-side load determination information and each piece of patient-side load determination information. Fig. 3 is a diagram showing an example of table information used when determining whether to raise or lower the elective medical treatment price for each piece of medical worker operating status information.

[0031] The example in Figure 3 shows that the price of non-refundable medical care is increased if the length of continuous working hours is longer than a threshold, and decreased if it is shorter than the threshold. The example in Figure 3 also shows that the price of non-refundable medical care is increased if the medical care location is within the hospital, and decreased if it is outside the hospital (at home). The example in Figure 3 also shows that the price of non-refundable medical care is decreased if the doctor's sleeping time is longer than a threshold, and decreased if it is shorter than the threshold. The example in Figure 3 also shows that the price of non-refundable medical care is increased if a highly difficult surgery is planned, and decreased if it is not.

[0032] FIG. 4 shows an example of table information used to determine whether to raise or lower the non-refundable medical treatment price for each occupancy information item. The example in FIG. 4 indicates that the non-refundable medical treatment price is raised when the number of outpatient appointments is greater than a threshold, and lowered when it is less than the threshold. The example in FIG. 4 also indicates that the non-refundable medical treatment price is raised when the number of outpatient appointments is greater than a threshold, and lowered when it is less than the threshold. The example in FIG. 4 also indicates that the non-refundable medical treatment price is lowered when the number of staff on duty is greater than a threshold, and raised when it is less than the threshold. The example in FIG. 4 also indicates that the non-refundable medical treatment price is lowered when the lead time until the appointment date is longer than a threshold, and raised when it is shorter. The example in FIG. 4 also indicates that the non-refundable medical treatment price is lowered when the lead time until the closing date is longer than a threshold, and raised when it is shorter.

[0033] FIG. 5 shows an example of table information used to determine whether to raise or lower the non-prescription medical treatment price for each piece of weather information. The example in FIG. 5 shows whether to raise or lower the non-prescription medical treatment price depending on whether the atmospheric pressure, temperature, and humidity are greater than their respective thresholds. The example in FIG. 5 also shows whether to raise or lower the non-prescription medical treatment price depending on whether the hours of sunshine are longer than their respective thresholds. The example in FIG. 5 also shows whether to raise or lower the non-prescription medical treatment price depending on whether the amount of precipitation, UV rays, wind, rain, snow, and lightning are greater than their respective thresholds.

[0034] Figure 6 shows an example of table information used to determine whether to raise or lower the non-refundable medical treatment price for each piece of traffic information. The example in Figure 6 shows that the non-refundable medical treatment price will be lowered if there is traffic congestion, construction work, traffic accidents, traffic restrictions due to abnormal weather or disasters, traffic restrictions due to security, traffic restrictions due to events, or traffic restrictions due to crime, but will be raised if there are no traffic restrictions.

[0035] The price calculation unit 13 compares the number of items determined to increase the elective medical treatment price with the number of items determined to decrease the elective medical treatment price based on the results of individual determinations for each of the multiple items shown in Figures 3 to 6, and calculates the elective medical treatment price according to whichever number is greater. That is, if the number of items determined to increase the elective medical treatment price is greater than the number of items determined to decrease the elective medical treatment price, the elective medical treatment price is increased from the base price. On the other hand, if the number of items determined to increase the elective medical treatment price is less than the number of items determined to decrease the elective medical treatment price, the elective medical treatment price is decreased from the base price.

[0036] The degree to which the elective medical treatment price is raised or lowered is determined based on the difference between the number of items determined to raise the elective medical treatment price and the number of items determined to lower the elective medical treatment price. For example, it is possible to set a unit adjustment price per difference and adjust the elective medical treatment price by the difference multiplied by the unit adjustment price. Note that if the number of items determined to raise the elective medical treatment price is the same as the number of items determined to lower the elective medical treatment price, the elective medical treatment price will remain the base price.

[0037] While the example described here is one in which a simple majority vote based on the results of individual determinations of each of the multiple items shown in Figures 3 to 6 determines whether to raise or lower the elective medical treatment price, the present invention is not limited to this. For example, weighting may be applied to the results of individual determinations of each of the multiple items shown in Figures 3 to 6. That is, for each of the multiple items, weight values ​​for adjustments to raise or lower the elective medical treatment price may be set as table information, and the decision on whether to raise or lower the elective medical treatment price and the extent to which to adjust it from the base price may be determined based on a comparison between the sum of the weight values ​​determined to raise the elective medical treatment price and the sum of the weight values ​​determined to lower it may be determined.

[0038] This weight value may be changed depending on the type of disease. That is, for a certain disease, atmospheric pressure may be a factor that affects symptoms, while temperature may not. The degree to which the effect on symptoms may vary depending on the type of disease. Therefore, table information may be prepared in which the weight value for adjusting the price of elective medical treatment in the direction of increasing or decreasing the price of elective medical treatment is changed for each type of disease, and the weight value may be determined based on the table information corresponding to the type of disease. Similarly, for traffic information, table information may be prepared in which the weight value for adjusting the price of elective medical treatment in the direction of increasing or decreasing the price of elective medical treatment is changed for each type of disease, and the weight value may be determined based on the table information corresponding to the type of disease.

[0039] Furthermore, instead of setting an adjustment weight value for each of the multiple items, an adjustment amount from the base price may be set for each of the multiple items. In this case, the non-medical treatment price can be determined by adding or subtracting the sum of the adjustment amounts determined to increase the non-medical treatment price and the sum of the adjustment amounts determined to decrease the non-medical treatment price from the base price. In other words, the non-medical treatment price = base price + sum of the increase adjustment amounts - sum of the decrease adjustment amounts.

[0040] As explained in detail above, in this embodiment, the non-refundable medical treatment price is calculated based on the medical institution side load determination information, which is the basis for estimating the medical institution's load on medical treatment, and the patient side load determination information, which is the basis for estimating the patient's physical or mental load. According to this embodiment configured in this way, the non-refundable medical treatment price is calculated based on the load conditions of both the medical institution and the patient, making it possible to present a non-refundable medical treatment price that is balanced for both the medical institution and the patient.

[0041] The elective medical treatment price calculation device 100 may provide the elective medical treatment price calculated as described above to the outpatient management system 300 and make it public, for example, through a reservation screen. Here, the elective medical treatment price calculation device 100 calculates the elective medical treatment price, for example, at regular time intervals, and provides the most recent elective medical treatment price to the outpatient management system 300 each time it calculates it. In this way, a patient who is trying to make a reservation for medical treatment by accessing the reservation screen of the outpatient management system 300 from a terminal can check the elective medical treatment price at that time and use it as reference information for deciding whether or not to make a reservation.

[0042] Furthermore, in the above embodiment, an example was described in which medical staff operating status information and medical institution vacancy information were used as information for determining a load on a medical institution, but only one of these pieces of information may be used. Furthermore, in the above embodiment, an example was described in which weather information and traffic information were used as information for determining a load on a patient, but only one of these pieces of information may be used. Furthermore, in the above embodiment, the information shown in Figures 3 to 6 was shown as examples of information for determining a load on a medical institution and information for determining a load on a patient, but this is just one example. It is not necessary to use all of this information, and other information may be used.

[0043] For example, activity information related to the activity status of the patient, indicating whether or not the patient is performing the target activity set between the medical institution and the patient, may be further used as information for determining patient burden. As an example, if the patient is performing the target activity or the achievement rate is higher than a threshold, the patient's burden is estimated to be low, and the price of elective medical treatment may be increased, and if the patient is not performing the target activity or the achievement rate is lower than the threshold, the patient's burden is estimated to be high, and the price of elective medical treatment may be decreased.

[0044] 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]

[0045] 11 Medical institution information acquisition department 12 Patient information acquisition department 13 Pricing Department 100 Free medical treatment price calculation device 200 Medical Personnel Management System 300 Outpatient Management System 400 Weather Information System 500 Traffic Information System

Claims

1. a medical institution side information acquisition unit that acquires medical institution side load determination information that serves as a basis for estimating the load situation of medical treatment at the medical institution; a patient-side information acquisition unit that acquires patient-side stress determination information that serves as a basis for estimating the patient's physical or mental stress status; a price calculation unit that calculates an elective medical treatment price based on the medical institution side burden determination information acquired by the medical institution side information acquisition unit and the patient side burden determination information acquired by the patient side information acquisition unit. A non-refundable medical treatment price calculation device.

2. The elective medical treatment price calculation device of claim 1, characterized in that the price calculation unit calculates the elective medical treatment price according to price calculation standards that increase the elective medical treatment price when information for determining the load on the medical institution side that is the basis for estimating that the load on the medical institution is high is acquired, while decreasing the elective medical treatment price when information for determining the load on the medical institution side that is the basis for estimating that the load on the medical institution is low is acquired, and decrease the elective medical treatment price when information for determining the load on the patient side that is the basis for estimating that the load on the patient is high is acquired, while increasing the elective medical treatment price when information for determining the load on the patient side that is the basis for estimating that the load on the patient is low is acquired.

3. 3. The elective medical treatment price calculation device according to claim 1, wherein the information for determining the load on the medical institution includes operating status information relating to the operating status of medical personnel at the medical institution.

4. 3. The elective medical treatment price calculation device according to claim 1, wherein the information for determining the load on the medical institution includes vacancy information relating to the capacity of the medical institution to accept patients.

5. 3. The elective medical treatment price calculation device according to claim 1, wherein the patient side load determination information includes meteorological information relating to weather that may be a factor affecting the patient's symptoms.

6. 3. The elective medical treatment price calculation device according to claim 1, wherein the patient side burden determination information includes traffic information relating to traffic conditions that may be a factor in burdening the patient when visiting the hospital.

7. The elective medical treatment price calculation device described in claim 1 or 2, characterized in that the patient-side load determination information includes activity information related to the activity status of whether or not the patient is carrying out the target activity set between the medical institution and the patient.

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