Medical cost decomposition analysis device, medical cost decomposition analysis method, and medical cost decomposition analysis program

Abstract

Appropriately allocate medical expenses according to injury or illness. [Solution] A medical treatment content code (medical procedure code, pharmaceutical code, specific equipment code, etc.) indicating the medical treatment content is read from the receipt summary information database, master information is referenced to read the illness name code associated with the read medical treatment content code, the illness name code associated with the read illness name code is selected from the illness name code included in the receipt illness name information database, and a process is performed to associate and output the illness name of the illness name code selected in the receipt illness name information database with the medical expenses associated with the medical treatment content code read in the receipt summary information database, and if there is a medical treatment content that is not associated with any of the illness name codes included in the receipt illness name information database, the medical expenses of the unassociated medical treatment content are allocated at a predetermined ratio to the illness name associated with the medical expenses.

Description

[Technical Field]

[0001] The present invention relates to a medical expense decomposition analysis device, a medical expense decomposition analysis method, and a medical expense decomposition analysis program. [Background technology]

[0002] To build and operate a health management promotion system, a medical record database based on actual medical records is used. This database is constructed for each health care provider using OCR conversion technology and a medical information database to convert information (heading, disease name, medical procedure) from paper receipts. This medical record database stores the medical records of all subscribers for each insurer in chronological order, allowing statistical analysis of data from various perspectives, such as by insured person and their family, medical institution, or disease. Therefore, technology for providing medical expense statistics information as a health care service has been disclosed (Patent Document 1).

[0003] Also disclosed is a medical expense decomposition analysis device that can identify which diseases a medical procedure or pharmaceutical treatment corresponding to multiple diseases listed on a medical receipt corresponds to (Patent Document 2). The device reads a medical procedure code or pharmaceutical code from the medical receipt information, and also reads an illness code associated with the same classification code as the medical procedure code or pharmaceutical code from master information. The device then searches the medical receipt information and selects an illness code that has the same receipt ID as the medical procedure code or pharmaceutical code and is included in the illness code. Furthermore, the device reads medical expenses associated with the medical procedure code or pharmaceutical code from the medical receipt information, and stores the read medical expenses as illness-related data in association with the selected illness code. [Prior art documents] [Patent documents]

[0004] [Patent Document 1] Japanese Patent Application Laid-Open No. 2004-288060 [Patent Document 2] Japanese Patent Application Laid-Open No. 2007-172187 Summary of the Invention [Problem to be solved by the invention]

[0005] However, in the conventional technology, when a medical treatment includes a medical treatment that cannot be associated with any injury or illness, it is not possible to allocate the medical expenses associated with the medical treatment to the appropriate injury or illness name. Therefore, there is a need for a medical expense breakdown analysis device, a medical expense breakdown analysis method, and a medical expense breakdown analysis program that can more appropriately allocate medical expenses that could not be allocated in the conventional technology. [Means for solving the problem]

[0006] One aspect of the present invention is a medical expense decomposition analysis device that can access a medical expense receipt injury / illness name information database that associates the injury / illness name recorded on a medical receipt with the injury / illness name code of the injury / illness name, a medical expense receipt summary information database that associates the medical treatment details recorded on a medical receipt with the medical treatment content code indicating the medical treatment content and the medical expenses of the medical treatment content, and master information that associates the injury / illness name code with the medical treatment content code, and the medical expense receipt injury / illness name information database reads the medical treatment content code indicating the medical treatment content from the medical expense receipt summary information database, references the master information, reads the injury / illness name code associated with the read medical treatment content code, and accesses the medical expense receipt injury / illness name information database. and selecting an injury or illness name code associated with the read-out injury or illness name code from among the injury or illness name codes included in the receipt injury or illness name information database, and performing a process of outputting the injury or illness name of the injury or illness name code selected in the receipt injury or illness name information database in association with the medical expenses associated with the medical treatment content code read out in the receipt summary information database, and by referring to the master information, if there is a medical treatment content that is not associated with any of the injury or illness name codes included in the receipt injury or illness name information database, allocating the medical expenses of the unassociated medical treatment content at a predetermined ratio to the injury or illness name associated with the medical expenses.

[0007] Here, it is preferable that the specified ratio is the ratio of medical expenses for each illness or injury name obtained by allocating the medical expenses for treatment associated with any illness or injury name out of the total medical expenses in the prescription summary information database to each illness or injury name.

[0008] Furthermore, if the medical treatment details included in the receipt summary information database are predetermined medical treatment details, it is preferable to associate the medical expenses of the medical treatment details, including the name of the suspected injury or illness.

[0009] Preferably, the predetermined medical treatment content is content related to an initial consultation, an examination, or an imaging diagnosis.

[0010] In addition, it is preferable that the medical expenses for a predetermined medical treatment be associated with the name of the injury or illness according to the start date of treatment for the injury or illness and the number of times the initial consultation fee is calculated. In addition, it is preferable that the predetermined medical treatment is related to the initial consultation.

[0011] Furthermore, when the medical treatment details included in the medical receipt summary information database are predetermined medical treatment details, it is preferable to associate the medical expenses of the medical treatment details only with the main illness or injury name. Furthermore, it is preferable that the predetermined medical treatment details are details related to medical management.

[0012] It is also preferable to change the order of the process of associating medical expenses with the names of illnesses and injuries for each medical treatment identification of the medical treatment details included in the medical receipt summary information database.

[0013] Another aspect of the present invention is a medical expense decomposition analysis program, which includes a medical expense claim information database associating a medical expense claim described on a medical receipt with a medical expense claim code for that medical expense claim, a medical expense claim summary information database associating a medical expense claim described on a medical receipt with a medical expense claim code indicating that medical expense claim, and master information associating the medical expense claim code with the medical expense claim code. The program reads out the medical expense claim code indicating the medical expense claim from the medical expense claim summary information database, references the master information, and reads out the medical expense claim code associated with the medical expense claim code included in the medical expense claim information database. a processing step of selecting an illness name code associated with the read-out illness name code from among the illness name codes to be read, associating and outputting the illness name of the illness name code selected in the receipt illness name information database with the medical expenses associated with the treatment content code read out in the receipt summary information database, and by referring to the master information, if there is a treatment content that is not associated with any of the illness name codes included in the receipt illness name information database, performing a processing step of allocating the medical expenses of the unassociated treatment content at a predetermined ratio to the illness name associated with the medical expenses.

[0014] Another aspect of the present invention is a method for decomposing and analyzing medical expenses, comprising: a medical receipt injury / illness name information database that associates the injury / illness name recorded on a medical receipt with the injury / illness name code of the injury / illness name; a medical receipt summary information database that associates the medical treatment details recorded on a medical receipt with the medical treatment content code indicating the medical treatment content and the medical expenses of the medical treatment content; and master information that associates the injury / illness name code with the medical treatment content code, the method comprising: reading out the medical treatment content code indicating the medical treatment content from the medical receipt summary information database; referring to the master information, reading out the injury / illness name code associated with the read-out medical treatment content code; and reading out the injury / illness name code included in the medical receipt injury / illness name information database. a process for selecting an injury or illness name code associated with the read-out injury or illness name code from among the injury or illness name codes included in the receipt injury or illness name information database, and outputting the injury or illness name of the injury or illness name code selected in the receipt injury or illness name information database and the medical expenses associated with the medical treatment content code read out in the receipt summary information database; and a process for allocating the medical expenses of the unassociated medical treatment content at a predetermined ratio to the injury or illness name associated with the medical expenses by referring to the master information if there is a medical treatment content that is not associated with any of the injury or illness name codes included in the receipt injury or illness name information database. [Effects of the Invention]

[0015] According to the present invention, medical expenses that were not properly allocated in the prior art can be appropriately allocated according to the injury or illness. Other objects of the embodiments of the present invention will become apparent by reference to the entire specification. [Brief explanation of the drawings]

[0016] [Figure 1] 1 is a diagram showing the configuration of a medical expense decomposition analysis device according to an embodiment of the present invention. [Figure 2] FIG. 10 is a diagram showing an example of a medical fee statement. [Figure 3] FIG. 10 is a diagram showing an example of a dispensing fee statement. [Figure 4]FIG. 2 is a diagram showing an example of a prescription injury / illness name information database in an embodiment of the present invention. [Figure 5] FIG. 2 is a diagram showing an example of a prescription summary information database in an embodiment of the present invention. [Figure 6] FIG. 10 is a diagram showing a medical treatment identification code (a code for identifying a medical procedure). [Figure 7] FIG. 3 is a diagram showing a configuration of master information according to an embodiment of the present invention. [Figure 8] FIG. 2 is a diagram showing an example of an injury / illness name master in an embodiment of the present invention. [Figure 9] FIG. 2 is a diagram showing an example of a medical care master according to an embodiment of the present invention. [Figure 10] FIG. 3 is a diagram showing an example of injury / illness related data according to an embodiment of the present invention. [Figure 11] FIG. 2 is a diagram showing an example of a data structure of a pharmaceutical product according to an embodiment of the present invention. [Figure 12] FIG. 2 is a diagram showing an example of a medicine master according to an embodiment of the present invention. [Figure 13] FIG. 2 is a diagram illustrating an example of a symptom master according to an embodiment of the present invention. [Figure 14] FIG. 3 is a diagram showing an example of injury / illness related data according to an embodiment of the present invention. [Figure 15] FIG. 10 is a diagram showing an example of a medical-to-medical master in the embodiment of the present invention. [Figure 16] FIG. 10 is a diagram showing an example of a medicine pair medical treatment master in the embodiment of the present invention. [Figure 17] FIG. 10 is a diagram showing an example of a prescription including specific equipment in an embodiment of the present invention. [Figure 18] FIG. 2 is a diagram showing an example of a prescription injury / illness name information database in an embodiment of the present invention. [Figure 19] FIG. 2 is a diagram showing an example of a prescription summary information database in an embodiment of the present invention. [Figure 20] FIG. 3 is a diagram showing an example of injury / illness related data according to an embodiment of the present invention. [Figure 21]FIG. 10 is a diagram showing an example of a prescription including specific equipment in an embodiment of the present invention. [Figure 22] FIG. 10 is a diagram showing an example of a prescription including specific equipment in an embodiment of the present invention. [Figure 23] FIG. 10 is a diagram showing an example of a prescription including specific equipment in an embodiment of the present invention. [Figure 24] FIG. 10 is a diagram showing an example of an equipment pair medical procedure master in the embodiment of the present invention. [Figure 25] FIG. 10 is a diagram showing an example of a prescription including specific equipment in an embodiment of the present invention. [Figure 26] FIG. 10 is a diagram showing an example of a prescription including specific equipment in an embodiment of the present invention. [Figure 27] 1 is a diagram illustrating the relationship between the date and time of the start of medical treatment on a receipt and the date and time of medical treatment in an embodiment of the present invention. FIG. [Figure 28] A figure showing an example of a receipt including an initial consultation fee in an embodiment of the present invention. [Figure 29] FIG. 3 is a diagram showing an example of injury / illness related data according to an embodiment of the present invention. [Figure 30] A figure showing an example of a receipt including an initial consultation fee in an embodiment of the present invention. [Figure 31] FIG. 3 is a diagram showing an example of injury / illness related data according to an embodiment of the present invention. [Figure 32] FIG. 3 is a diagram showing an example of injury / illness related data according to an embodiment of the present invention. [Figure 33] FIG. 3 is a diagram showing an example of injury / illness related data according to an embodiment of the present invention. [Figure 34] FIG. 3 is a diagram showing an example of injury / illness related data according to an embodiment of the present invention. [Figure 35] 10 is a flowchart showing a medical cost decomposition analysis process according to an embodiment of the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0017] [Device configuration] 1, a medical cost decomposition analysis device 100 according to an embodiment of the present invention includes a processing unit 10, a memory unit 12, an input unit 14, an output unit 16, and a communication unit 18. The medical cost decomposition analysis device 100 may be connected to an external information processing device installed in a medical institution, a dispensing pharmacy, or the like, via an information and communication network 102 such as the Internet, so as to be able to exchange information with the external information processing device.

[0018] The information and communications network 102 is not limited to the Internet, but may be any network that can connect the medical expense decomposition analysis device 100 and external devices to each other so that they can communicate with each other. For example, it may be a dedicated line, a public line (telephone line, mobile communication line, etc.), a wired LAN (Local Area Network), a wireless LAN, etc., or a combination of these.

[0019] The processing unit 10 includes a means for performing arithmetic processing, such as a CPU. The processing unit 10 executes a medical expense decomposition analysis program stored in the memory unit 12, thereby performing a medical expense decomposition analysis process in the medical expense decomposition analysis device 100, analyzing medical information and appropriately allocating medical expenses. The memory unit 12 includes a storage means, such as a semiconductor memory or a memory card. The memory unit 12 is accessible and connected to the processing unit 10, and stores the medical expense decomposition analysis program and information necessary for the process. The input unit 14 includes a means for inputting information. The input unit 14 includes, for example, a keyboard, a touch panel, buttons, etc., for receiving input from a user. The output unit 16 includes a user interface screen (UI) for receiving information input from a user and a means for outputting the results of the medical expense decomposition analysis process. The output unit 16 includes, for example, a display. The communication unit 18 includes an interface for communicating information with an external device via the information and communication network 102. Communication by the communication unit 18 may be wired or wireless.

[0020] The medical expense decomposition analysis device 100 can be a stationary or portable game console, a stationary or portable personal computer (PC), a tablet computer, a smartphone, a mobile phone terminal, a PHS (Personal Handy-phone System) terminal, a personal digital assistant (PDA), a multi-function television receiver with information processing capabilities (so-called smart TV), etc.

[0021] [Receipt and information database] The following describes the configuration of the medical receipt and various information databases in the medical expense decomposition analysis device 100. The medical receipt information and various information databases are stored in the storage unit 12 of the medical expense decomposition analysis device 100.

[0022] Figure 2 shows an example of a medical fee statement (receipt) issued when a patient undergoes medical procedures such as consultations, medication, tests, and surgery at a medical institution. The medical fee statement is a document used by a medical institution to bill an insurer (such as a health insurance association or national health insurance) when the medical institution provides insured medical care. The medical fee statement contains details of the medical treatments, procedures, tests, medications, etc. that the patient received, and the insurer uses this information to pay medical fees to the medical institution.

[0023] A medical fee statement contains basic information such as statement number, medical record number, reception number, year and month the statement was issued, patient name, gender, date of birth, insurer number, symbol / number, insurer name, name and address of the medical institution that provided the treatment, telephone number, date of consultation, etc. A medical fee statement also contains information on the details of treatment, indicating the specific treatment or procedure, the points charged for the treatment (points that serve as the basis for costs), medication information such as the type, quantity, and method of use of prescribed medication, information on examinations and imaging diagnostics performed, and information on the points charged for medication, examinations, imaging diagnostics, etc.

[0024] Figure 3 shows an example of a dispensing fee statement (receipt) issued when a drug is prescribed at a dispensing pharmacy. The dispensing fee statement contains detailed information about the drug dispensing fee for the patient. The dispensing fee statement includes basic information such as the statement number, receipt number, reception number, the year and month the statement was issued, the patient's name, gender, date of birth, insurer number, code / number, insurer name, the name and location of the medical institution that issued the prescription, and the doctor's name. The dispensing fee statement also includes information about the medical treatment details of the prescribed drug, such as the drug name, dosage form, and usage / dosage, as well as the dispensed quantity, drug fee, dispensing fee, and pharmaceutical management fee points, and the insurance coverage ratio.

[0025] In this embodiment, medical procedures (medical procedures, medication, injections, treatments, surgeries, tests / pathology, diagnostic imaging, hospitalization, etc.) for which points are assigned in relation to medical insurance claims as stipulated by the Ministry of Health, Labor and Welfare (Minister of Health, Labor and Welfare) are collectively referred to as medical treatment details. That is, the contents for which points (amounts) are assigned in the medical treatment procedure master, pharmaceutical master, specified equipment master, dental treatment procedure master, dispensing procedure master, and home nursing care fee master for medical insurance claims provided by the payment fund are referred to as medical treatment details, and the medical treatment code, pharmaceutical code, specified equipment code, dental treatment procedure code, dispensing procedure code, and home nursing care fee code contained in each of the above masters are referred to as medical treatment content codes.

[0026] The medical expense decomposition analysis device 100 extracts information from these medical receipts and generates various information databases that serve as source data for the medical expense decomposition analysis process. Figure 4 shows an example of a medical receipt illness / injury name information database. Figure 5 shows an example of a medical receipt summary information database.

[0027] The receipt illness name information database stores the insurer number, treatment year and month, receipt number, medical institution code, treatment start date, illness name, illness name code, main illness name, and suspicion flag extracted from the receipt, in association with each other. Of these, the receipt number is an identification number uniquely assigned to each receipt, such as in medical fee statements and dispensing fee statements. The medical institution code is an identification number uniquely assigned to the medical institution that issued the receipt. The illness name code is a 7-digit fund code used by the payment fund and is a code uniquely assigned to each illness name. The illness name code is expressed in the range of 0010000 to 9999999. The main illness name is set to 1 for illness names that are written as (main) in the illness name column of the receipt, and 0 for other illness names. In addition, the suspicion flag is set to 1 for illness names that are written as "suspected of (illness name)" in the illness name column of the receipt, and 0 for other illness names. For example, if it is written that "suspected liver function decline" is present, the suspicion flag is set to 1 in association with the name of the injury or illness "liver function decline."

[0028] The medical receipt summary information database extracts information from these receipts and stores the following in association with each other: insurer number, medical treatment year and month, receipt number, medical institution code, type, medical treatment identification code, medical treatment content code (medical treatment code, pharmaceutical code, specific equipment code, etc.), medical treatment content (medical treatment, pharmaceutical, specific equipment, etc.), amount used, points, and number of times. Among these, type is information indicating the type of medical receipt from which data such as medical fee statement and dispensing fee statement was extracted. Medical treatment identification code is an identification number indicating the medical treatment content. The medical treatment identification code indicates the type of medical treatment, treatment, medication, surgery, etc., performed. Figure 6 shows the relationship between medical treatment identification code and medical treatment. Medical treatment content code (medical treatment code, pharmaceutical code, specific equipment code, etc.) is a nine-digit code indicating the medical treatment content such as medical treatment, pharmaceutical, specific equipment, etc. For example, medical treatment code is expressed in the range of 100000000 to 199999999. Pharmaceutical codes are expressed in the range of 600000000 to 699999999. Specific equipment codes are expressed in the range of 700000000 to 799999999. The amount used, points, and number of times are information that indicates medical costs.

[0029] In this way, necessary information is extracted from prescriptions including medical fee statements and dispensing fee statements, and a prescription illness / injury name information database and prescription summary information database are generated, which serve as the source data for medical expense breakdown analysis.

[0030] [Medical cost decomposition analysis processing] The following describes the medical expense decomposition analysis process in the medical expense decomposition analysis device 100. The medical expense decomposition analysis process allocates medical expenses to illness names using various master information based on the receipt illness name information database and the receipt summary information database.

[0031] 7, the master information includes a medical procedure basic master 200, an injury / illness name basic master 220, and a pharmaceutical basic master 240. The medical procedure basic master 200, the injury / illness name basic master 220, and the pharmaceutical basic master 240 are stored in advance in the storage unit 12 of the medical expense decomposition analysis device 100. The medical procedure basic master 200, the injury / illness name basic master 220, and the pharmaceutical basic master 240 may also be stored in advance in an external device accessible from the medical expense decomposition analysis device 100 via the communication unit 18.

[0032] The medical procedure basic master 200 is composed of a medical treatment-to-medical treatment master 202 that defines the correspondence between medical procedures, a medical procedure master 204 that corresponds medical procedures to codes, and an equipment-to-medical procedure master 206 that corresponds medical procedures to specific equipment. The illness name basic master 220 is composed of an illness name master 222 that corresponds illness names to codes. The drug basic master 240 is composed of a symptom master 242 that defines the correspondence between symptoms and codes, a drug master 244 that defines the correspondence between drugs and codes, and a drug-to-medical treatment master 246 that defines the correspondence between drugs and medical procedures.

[0033] <Processing to allocate medical expenses for medical treatment by injury or illness> This section explains the process of allocating medical expenses based on medical procedures listed on medical receipts by illness or injury. The following medical expense breakdown analysis process is performed on information associated with the same insured person number and the same treatment date in the medical receipt illness or injury name information database and the medical receipt summary information database.

[0034] The injury / illness name master 222 is master information that stores injury / illness name codes, injury / illness names, and classification codes in association with each other, as shown in Fig. 8. The injury / illness name code is a seven-digit fund code used by the Ministry of Health, Labor, and Welfare, as described above, and is a code uniquely assigned to each injury / illness name. The classification code is a code assigned to the injury / illness name, and is a code that groups injuries / illnesses based on the top 12 digits.

[0035] For example, in the example in Figure 8, seasonal allergic rhinitis, perennial allergic rhinitis, and allergic rhinitis are grouped by the classification code "100401001030." Similarly, other illnesses and injuries are grouped by the first 12 digits of their classification codes depending on their characteristics.

[0036] As shown in Figure 9, the medical treatment master 204 is master information that stores medical treatment codes, classification codes, names, and illness name classification codes in association with each other. The classification codes are classification codes listed in the medical fee point chart. The classification codes are used in association with other medical treatments and medicines. The illness name classification code is a code for association with the illness name. The first 12 digits of the illness name classification code are associated with the classification code in the illness name master 222.

[0037] As described above, the information relating to the disease name in the disease name master 222 and the information relating to the medical treatment in the medical treatment master 204 are associated with each other via classification codes.

[0038] The medical expense decomposition analysis device 100 sequentially reads out information relating to medical treatment details contained in the medical receipt summary information database for each medical treatment detail (i.e., for each row in the medical receipt summary information database). It compares the medical treatment details code (medical treatment code) relating to the medical treatment among the read information with the medical treatment code in the medical treatment master 204, and extracts the injury / illness name classification code corresponding to the matching medical treatment code from the medical treatment master 204. It also compares the injury / illness name classification code extracted from the medical treatment master 204 with the classification code in the injury / illness name master 222, and extracts all injury / illness name codes associated with the matching classification code.

[0039] Next, the receipt illness name information database is referenced to check whether the receipt illness name information database contains an illness name code that matches the illness name code extracted from the illness name master 222. If the receipt illness name information database contains an illness name code that matches the illness name code extracted from the illness name master 222, information associated with the matching illness name code is read from the receipt illness name information database, and the information is output as illness-related data in association with information on the medical treatment (medical treatment) previously read from the medical treatment summary information database. If the receipt illness name information database does not contain an illness name code that matches the illness name code extracted from the illness name master 222, i.e., if the medical treatment read from the medical treatment summary information database does not contain an illness name directly associated with the medical treatment read from the medical treatment summary information database, the medical expenses corresponding to the medical treatment are subject to proportional allocation. The proportional allocation process will be described later.

[0040] In the above process, master information directly associating medical procedure codes with medical procedure codes may be used without applying the illness classification code. In this case, the illness code associated with the medical procedure code (medical procedure code) read from the medical receipt summary information database is extracted from the master information, and the illness code is compared with the medical receipt illness name information database. Information associated with the matching illness code is then read from the medical receipt illness name information database, associated with the information on the medical procedure previously read from the medical receipt summary information database, and output as illness-related data.

[0041] Furthermore, if the medical treatment details (medical procedures) are related to an initial consultation, examination, or diagnostic imaging, matching is also performed on illnesses and injuries for which the suspicion flag is set to 1 in the medical receipt illness name information database, and the illness and medical treatment details (medical procedures) are associated and output as illness-related data. Specifically, if the medical treatment identification code is 11 (initial consultation), 60 (examination), or 70 (diagnostic imaging), matching is also performed on illnesses and injuries, regardless of whether the suspicion flag is set to 0 or 1 in the medical receipt illness name information database, and the illness and medical treatment details (medical procedures) are associated. In contrast, if the medical treatment details (medical procedures) are related to follow-up consultations, medical management, home care, general medication, general injections, procedures, surgery, anesthesia, other, general hospitalization-related matters, or the prescription field of a prescription, matching is not performed on illnesses and injuries for which the suspicion flag is set to 1 in the medical receipt illness name information database, and the illness and medical treatment details (medical procedures) are not associated; only illnesses and injuries for which the suspicion flag is set to 0 are matched and associated with the illness and medical treatment details (medical procedures). Specifically, for medical identification codes 12 (re-examination), 13 (medical management), 14 (home care), 21-28 (general medication), 31-33, 39 (general injections), 40 (treatment), 50 (surgery), 54 (anesthesia), 80 (other), 90, 92, 97 (general hospitalization-related) and the prescription column of a prescription, no matching will be performed for illnesses with a suspicion flag of 1 in the prescription illness name information database, and no association will be made between the illness and medical treatment content (medical procedure).

[0042] However, if the receipt contains only suspected illnesses and injuries, it is preferable to treat all illnesses and injuries as non-suspected illnesses and injuries.

[0043] The same approach applies to the above-mentioned processing related to the suspicion flag in all the sorting processing (including the exceptions) described below.

[0044] 10 shows an example of injury / illness-related data output from the medical expense decomposition analysis device 100. The injury / illness-related data associates the insurer number, treatment year / month, receipt number, medical institution code, treatment start date, injury / illness name, injury / illness name code, main illness name, suspicion flag, summary item {treatment content code (treatment procedure code, drug code, specific equipment code, etc.), treatment content (treatment, drug, specific equipment, etc.)}, usage amount, points, and number of times.

[0045] <Processing for allocating medical expenses for pharmaceuticals by illness> Next, the process of allocating medical expenses for medicines by illness will be described.

[0046] The Ministry of Health, Labour and Welfare manages pharmaceuticals using payment fund codes that represent product names. Information relating pharmaceuticals to illnesses and injuries is written in the efficacy and effects section of the pharmaceutical package insert. In this embodiment, the generic names of pharmaceuticals written on the pharmaceutical package insert are coded, and the information relating generic names and illnesses and injuries is stored and used as a symptom master 242 and a pharmaceutical master 244.

[0047] For example, the package insert for omeprazole tablets lists the generic name "omeprazole enteric-coated tablets." This generic name is associated with the generic name code of the drug, as shown in Figure 11(a). Furthermore, generic name codes are assigned to drugs related to omeprazole tablets, as shown in Figure 11(b). Furthermore, the symptoms listed in the efficacy and effects column of the package insert are associated with the generic name code, as shown in Figure 11(c).

[0048] Figure 12 shows an example of the drug master 244. The drug master 244 stores a drug code (fund code) corresponding to the drug payment fund code, a generic name code, and the name of the drug in association with each other. Figure 13 shows an example of the symptom master 242. The symptom master 242 stores a generic name code, a symptom name, and an injury / disease classification code in association with each other.

[0049] The medical expense decomposition analysis device 100 sequentially reads information related to medical treatment details contained in the receipt summary information database for each medical treatment detail (i.e., for each row in the receipt summary information database). It compares the medical treatment details code (drug code) related to pharmaceuticals among the read information with the pharmaceutical code (fund code) in the pharmaceutical master 244, and extracts the generic name code corresponding to the matching pharmaceutical code (fund code) from the pharmaceutical master 244. It also compares the generic name code extracted from the pharmaceutical master 244 with the generic name code in the symptom master 242, and extracts all the injury / illness name classification codes of the symptoms corresponding to the matching generic name code. It also compares the injury / illness name classification code extracted from the symptom master 242 with the classification code in the injury / illness name master 222, and extracts all the injury / illness name codes associated with the matching classification code.

[0050] Next, the medical receipt illness name information database is referenced to check whether the medical receipt illness name information database contains an illness name code that matches the illness name code extracted from the illness name master 222. If an illness name code that matches the illness name code extracted from the illness name master 222 is included, information associated with the matching illness name code is read from the medical receipt illness name information database, and the information is output as illness-related data in association with information about the drug previously read from the medical receipt summary information database. If an illness name code that matches the illness name code extracted from the illness name master 222 is not included, i.e., if the medical receipt illness name information database does not contain an illness name directly associated with the drug read from the medical receipt summary information database, the medical expenses corresponding to the drug are subject to proportional allocation. Proportional allocation will be described later.

[0051] In the above process, master information directly linking the pharmaceutical fund code and the illness code may be used instead of applying the generic name code. In this case, the illness code associated with the medical treatment code (pharmaceutical code) read from the medical receipt summary information database is extracted from the master information, and the illness code is compared with the medical receipt illness name information database. Then, information associated with the matching illness code is read from the medical receipt illness name information database, and the information is output as illness-related data in association with the information on the pharmaceutical previously read from the medical receipt summary information database.

[0052] 14 shows an example of injury / illness-related data output from the medical expense decomposition analysis device 100. The injury / illness-related data associates the insurer number, treatment year / month, receipt number, medical institution code, treatment start date, injury / illness name, injury / illness name code, main illness name, suspicion flag, summary item {treatment content code (treatment procedure code, drug code, specified equipment code, etc.), treatment content (treatment, drug, specified equipment, etc.)}, usage amount, points, and number of times.

[0053] <Exceptions to the process of allocating medical expenses for medical treatment by injury or illness> Next, we will explain how to handle cases where the medical expenses for medical procedures that cannot be directly allocated to the name of an illness are included in the summary section of a medical receipt. For example, if the summary section of a medical receipt states "Mucous membrane ink puncture and ink hosho surcharge," this medical expense cannot be allocated to the name of an illness. This is because the "Mucous membrane ink puncture and ink hosho surcharge," which is the technical fee for the medical procedure, cannot be directly associated with the name of an illness.

[0054] In such cases, the medical treatment (or related treatment such as technical fees related to the medical treatment) is allocated to the name of the injury or illness using the medical treatment master 202 that associates the injury or illness name code with the medical treatment code or the medical treatment codes with each other.

[0055] FIG. 15 shows an example of the medical treatment-to-medical treatment master 202. The medical treatment-to-medical treatment master 202 stores an original code, an original medical procedure, a patient code, and a classification in association with each other. The original code is a code assigned uniquely to a medical procedure that is not directly associated with the name of an injury or illness. The original medical procedure is the name of the medical procedure corresponding to the original code. The patient code is either a medical procedure content code or a medical procedure classification code associated with the original code and the medical procedure. The classification is set to 0 if the patient code is a medical procedure content code, and 1 if the patient code is a medical procedure classification code.

[0056] The medical expense decomposition analysis device 100 reads out information related to medical treatment details contained in the receipt summary information database. It compares the medical treatment details code (medical treatment code) from the read out information with the medical treatment code in the medical treatment master 204, and if there is no matching medical treatment code in the medical treatment master 204, it performs the following processing using the medical treatment-to-medical treatment master 202.

[0057] The medical expense decomposition analysis device 100 searches for an original code that matches the medical treatment content code (medical procedure code) from the read information by referring to the treatment-to-treatment master 202. Then, it extracts the other party code that corresponds to the matching original code from the treatment-to-treatment master 202.

[0058] Next, if the category associated with the extracted other party code is 0, it is compared with the medical procedure code in the medical procedure master 204. If a medical procedure code matching the extracted other party code exists in the medical procedure master 204, the illness / injury classification code associated with that medical procedure code is extracted. Furthermore, the illness / injury classification code extracted from the medical procedure master 204 is compared with the classification code in the illness / injury name master 222, and all illness / injury names associated with the matching classification code are extracted.

[0059] On the other hand, if the category associated with the extracted other party code is 1, it is compared with the classification code in the medical procedure master 204. If a classification code matching the extracted other party code exists in the medical procedure master 204, the injury / illness name classification code associated with that classification code is extracted. Furthermore, the injury / illness name classification code extracted from the medical procedure master 204 is compared with the classification code in the injury / illness name master 222, and all injury / illness name codes associated with the matching classification code are extracted.

[0060] The receipt illness name information database is then referenced to check whether the receipt illness name information database contains an illness name code that matches the illness name code extracted from the illness name master 222. If the receipt illness name information database contains an illness name code that matches the illness name code extracted from the illness name master 222, information associated with the matching illness name code is read from the receipt illness name information database, and the information is output as illness-related data in association with information on the medical treatment (medical treatment) previously read from the medical treatment summary information database. If the receipt illness name information database does not contain an illness name code that matches the illness name code extracted from the illness name master 222, i.e., if the medical treatment read from the medical treatment summary information database does not contain an illness name directly associated with the medical treatment read from the medical treatment summary information database, the medical expenses corresponding to the medical treatment are subject to proportional allocation. The proportional allocation process will be described later.

[0061] <Exceptions to the process of allocating medical expenses for pharmaceuticals by illness> Next, we will explain how to handle cases where the medical expenses for medicines that cannot be directly allocated to the name of an illness or injury are included in the medical receipt summary. For example, if the medical receipt summary contains medicines that cannot be directly associated with the name of an illness or injury, such as medicines administered during diagnostic imaging, the medical expenses cannot be allocated to the name of an illness or injury.

[0062] In such a case, the medicines are assigned to the names of the illnesses and injuries using the medicine-treatment master 246 that defines the correspondence between the medicines and the treatments.

[0063] FIG. 16 shows an example of the medicine-to-treatment master 246. The medicine-to-treatment master 246 stores generic name codes, symptom names, and medical procedure classification codes in association with each other. The generic name code is a code uniquely assigned to each generic name of a medicine. The symptom name can be, for example, the efficacy and effect name on the package insert of the medicine. The medical procedure classification code is a code for associating with a medical procedure, and is used to link with the classification code in the medical procedure master 204.

[0064] The medical expense decomposition analysis device 100 reads information about medical treatment details (drugs) included in the receipt summary information database. The medical treatment details code (drug code) among the read information about the drug is compared with the drug code (funding code) in the drug master 244, and a generic name code corresponding to the matching drug code (funding code) is extracted from the drug master 244. The generic name code extracted from the drug master 244 is then compared with the generic name code in the drug-to-treatment master 246, and a medical procedure classification code corresponding to the matching generic name code is extracted from the drug-to-treatment master 246. Next, the extracted medical procedure classification code is compared with the classification code in the medical procedure master 204. If a classification code matching the extracted medical procedure classification code exists in the medical procedure master 204, the medical procedure code and illness / injury classification code associated with the classification code are extracted. Furthermore, the injury / injury classification code extracted from the medical procedure master 204 is compared with the classification code in the injury / injury name master 222, and the injury / injury code associated with the matching classification code is extracted.

[0065] Then, the receipt summary information database is referenced, and the medical treatment content (medical treatment) associated with the medical treatment content code (medical treatment code) that matches the medical treatment code extracted from the medical treatment master 204 is extracted from the receipt summary information database.

[0066] Furthermore, if the medical treatment details (medical procedure) can be extracted from the medical receipt summary information database, a comparison is made to determine whether the medical receipt illness name information database contains a matching illness name code extracted from the illness name master 222. If a matching illness name code extracted from the illness name master 222 is included, information associated with the matching illness name code is read from the medical receipt illness name information database, and the information is output as illness-related data in association with information about the drug previously read from the medical receipt summary information database. If a matching illness name code extracted from the illness name master 222 is not included, i.e., if the medical receipt illness name information database does not contain a name that is directly associated with the medical procedure read from the medical receipt summary information database, the medical expenses corresponding to the drug are subject to proportional allocation. The proportional allocation process will be described later.

[0067] In the above process, master information directly linking drug codes and medical procedure codes may be used instead of applying generic name codes and classification codes. In this case, the medical procedure code associated with the medical procedure code (drug code) read from the medical receipt summary information database is extracted from the master information, and the medical procedure code is compared with the injury / illness-related data. Then, information directly linked to the matching medical procedure code is read from the injury / illness-related data, and the information is output as injury / illness-related data in association with the information about the drug previously read from the medical receipt summary information database.

[0068] <Processing for allocating medical expenses related to specific equipment by injury or illness> A medical receipt may contain information about specific equipment (specific health care materials) that cannot be assigned to an illness or injury using the above process. In the medical receipt summary information database, this specific equipment is represented by a medical treatment content code whose first digit begins with 7 (or the record identification is represented by TO).

[0069] Figure 17 shows an example of a medical receipt that includes information about specific equipment. In this receipt, the item "endoscope film cost" corresponds to the specific equipment.

[0070] Figure 18 shows an example of a receipt illness / injury name information database generated from the receipt. Figure 19 shows an example of a receipt summary information database generated from the receipt. In the receipt summary information database shown in Figure 19, the "endoscope film cost" surrounded by a bold frame is information about a specific device.

[0071] When allocating medical expenses for specific equipment, different allocation procedures are applied to medical expenses for specific equipment whose medical identification codes listed on the receipt are 40 (treatment), 50 (surgery), 54 (anesthesia), and 60 (examination), and to medical expenses for specific equipment that belong to other medical identification codes.

[0072] For specific equipment with a medical treatment identification code of 40 (procedure), 50 (surgery), 54 (anesthesia), or 60 (examination), a process is performed to associate it with the first medical treatment in a group of medical treatments that belong to the same medical treatment identification code. Here, a group of medical treatments refers to the group of medical treatments listed on the receipt from when an identification code is set until the next medical treatment identification code is set. Note that although medical treatment identification codes 50 (surgery) and 54 (anesthesia) are different codes, they are treated together as one group.

[0073] In the case of the receipt shown in Figure 17, the medical treatment details from "EF-Stomach / Duodenum" to "Xylocaine Jelly 2% 5mL," for which the medical treatment identification code "60" related to the test is set, are processed as one group. In the receipt summary information database shown in Figure 19, the group of medical treatments described from when a medical treatment identification code is set until the next medical treatment identification code is set is also treated as one group.

[0074] The medical expense decomposition analysis device 100 reads information related to medical treatment details contained in the receipt summary information database, and processes any read information in which the first digit of the medical treatment details code is "7" as information related to specific equipment. If the medical treatment identification code associated with the specific equipment is 40 (procedure), 50 (surgery), 54 (anesthesia), or 60 (examination), it searches for the first medical procedure in the group that belongs to the same medical treatment identification code, and allocates the medical expenses related to the specific equipment by illness or injury based on the medical treatment details code associated with that medical procedure, and outputs the results as illness-related data.

[0075] The process of extracting the name of the illness or injury associated with the medical content code (medical procedure code) associated with the first medical procedure in the group may be performed based on the process of allocating the medical expenses of the above medical procedure by the name of the illness or injury, or on an exception to the process of allocating the medical expenses of the medical procedure by the name of the illness or injury.

[0076] In the case of the receipt in Figure 17 and the receipt summary information database in Figure 19, "Endoscopic film cost," which has a medical treatment content code of 700590000, corresponds to the specific equipment. Therefore, the first medical treatment content in the same group, "EF-Stomach / Duodenum," is searched for, and association with the illness name is performed based on the medical treatment content code (medical treatment code) associated with that medical treatment, 160093810. In this case, the same process as the process of allocating the medical expenses for the above medical treatment by illness name is executed, and information such as medical expenses related to "Endoscopic film cost" is associated with "Gastric submucosal tumor" in the receipt illness name information database in Figure 18, and output as illness-related data.

[0077] Figure 20 shows an example of output of injury / illness related data. In this injury / illness related data, information on medical expenses etc. related to the specific equipment "endoscope film cost" is associated with the same injury / illness name "gastric submucosal tumor" as the first "EF-stomach / duodenum" in the group of the same medical treatment identification code.

[0078] As shown in Figure 21, the specific equipment "Endoscope film cost" is associated with the first medical treatment content in the same group, "EF-Stomach / Duodenum," but if there is no illness or injury name associated with that medical treatment content, the medical expenses for that specific equipment will be subject to proportional allocation. Proportional allocation will be described later.

[0079] As mentioned above, the medical treatment identification codes 50 (surgery) and 54 (anesthesia) are different codes, but they are treated as one group. In other words, if a receipt contains medical treatments with medical treatment identification codes 50 (surgery) and 54 (anesthesia), and the medical treatments contain an item for special equipment whose first digit of the medical treatment identification code is 7, the medical treatments will be processed in association with the first medical treatment that belongs to the same group.

[0080] For example, as shown in Figure 22, in a receipt containing medical treatments with medical treatment identification codes 50 (surgery) and 54 (anesthesia), the item "liquid nitrogen / stationary liquefied oxygen tank," whose first digit of the medical treatment code is 7, corresponds to special equipment. In this case, the "liquid nitrogen / stationary liquefied oxygen tank" is treated as a group of medical treatments with medical treatment identification codes 50 (surgery) and 54 (anesthesia), and is associated with the first medical treatment (procedure) in that group, "gastrectomy (malignant tumor surgery)." Then, when the medical treatment "gastrectomy (malignant tumor surgery)" is associated with the disease name "gastric body cancer (primary)" through the process of allocating medical expenses for the above medical treatment by disease name, the medical expenses and other information related to the special equipment "liquid nitrogen / stationary liquefied oxygen tank" is allocated to the disease name "gastric body cancer (primary)."

[0081] As shown in Figure 23, if there is no medical procedure associated with the specified equipment "liquid nitrogen / stationary liquefied oxygen storage tank," the medical expenses for that specified equipment will be subject to proportional allocation. Also, if there is a medical procedure related to the specified equipment "liquid nitrogen / stationary liquefied oxygen storage tank," but the illness / disease name associated with that medical procedure does not exist in the receipt illness / disease name information database, the medical expenses for that specified equipment will also be subject to proportional allocation. Proportional allocation will be described later.

[0082] Furthermore, for medical expenses for specific equipment that belongs to a medical identification code other than 40 (treatment), 50 (surgery), 54 (anesthesia), or 60 (examination), the medical expenses for that specific equipment are allocated using the equipment-to-medical procedure master 206. For example, if the medical details for a medical identification code of 12 (revisit), 13 (medical management), 14 (home care), 70 (imaging diagnosis), 80 (other), or 90 or 92 (hospitalization fee-related) include an item for a specific equipment, the medical expenses for that specific equipment are allocated using the equipment-to-medical procedure master 206.

[0083] 24 shows an example of the equipment-to-medical procedure master 206. The equipment-to-medical procedure master 206 stores, in association with each other, medical procedure codes (specific equipment codes), specific equipment names corresponding to the medical procedure codes (specific equipment codes), medical procedure codes (medical procedure codes) associated with the specific equipment, and the medical procedure names.

[0084] The medical expense decomposition analysis device 100 reads information regarding medical treatment details contained in the prescription summary information database, and performs the following processing if the information contains an item for specific equipment whose first digit of the medical treatment details code is 7 and corresponds to a medical treatment identification code other than one of 40 (treatment), 50 (surgery), 54 (anesthesia), or 60 (examination).

[0085] The medical treatment content code (specific equipment code) of the read specific equipment is compared with the medical treatment content code (specific equipment code) in the equipment-to-medical procedure master 206, and the medical treatment content code (medical procedure code) corresponding to the matching medical treatment content code (specific equipment code) is extracted from the equipment-to-medical procedure master 206.

[0086] Furthermore, the medical treatment content code (medical treatment code) extracted from the equipment-to-medical treatment master 206 is compared with the medical treatment code in the medical treatment master 204, and all injury / illness name classification codes associated with the medical treatment corresponding to the matching medical treatment code are extracted.

[0087] Then, the injury / illness name classification code extracted from the medical treatment master 204 is compared with the classification code in the injury / illness name master 222, and all injury / illness name codes associated with the matching classification code are extracted.

[0088] Next, the medical receipt injury / illness name information database is referenced to check whether or not the medical receipt injury / illness name information database contains an injury / illness name code that matches the injury / illness name code extracted from the injury / illness name master 222. If the medical receipt injury / illness name information database contains an injury / illness name code that matches the injury / illness name code extracted from the injury / illness name master 222, information associated with the matching injury / illness name code is read from the medical receipt injury / illness name information database, and output as injury / illness-related data in association with information such as medical expenses related to the specific equipment that was previously read from the medical receipt summary information database.

[0089] For example, as shown in Figure 25, in a receipt containing a medical treatment with a medical treatment identification code of 70 (imaging diagnosis), the item "Mammography Film (18x24)" whose first digit of the medical treatment identification code is 7 corresponds to special equipment. Since the medical treatment code for "Mammography Film (18x24)" is "700330000," all medical treatment codes for medical treatments associated with the specific equipment medical treatment code "700330000" are extracted by referring to the equipment-to-medical treatment master 206. For example, medical treatment codes including the medical treatment code "170027010" for mammography (analog radiography) associated with the medical treatment code "700330000" are read out. Next, the medical treatment master 204 is referenced to extract the injury / illness classification code for the medical treatment associated with the extracted medical treatment code. For example, the illness / injury name classification code "0201030102580" associated with the medical treatment content code "170027010" for mammography (analog radiography) is extracted. Then, by referring to the illness / injury name master 222, all illness / injury name codes having classification codes matching the extracted illness / injury name classification code are extracted. For example, the illness / injury name code "8838474" for breast nodule associated with the illness / injury name classification code "0201030102580" is extracted. Furthermore, by referring to the illness / injury name information database, a check is made to see whether the illness / injury name code matching the illness / injury name code "8838474" extracted from the illness / injury name master 222 is included in the illness / injury name information database. For example, if the illness name master 222 contains an illness name code for a breast nodule that matches the illness name code "8838474," the information on the breast nodule associated with the matching illness name code is linked to information on medical expenses, etc. related to the specific equipment "mammography film (18x24)" that was previously read from the prescription summary information database, and output as illness-related data.

[0090] As shown in Figure 23, if there is no medical procedure associated with a specific equipment on a receipt, the medical expenses for that specific equipment are subject to proportional allocation. Also, if there is no medical procedure associated with a specific equipment in the equipment-to-medical procedure master 206, the medical expenses for that specific equipment are subject to proportional allocation. Also, if there is a medical procedure associated with a specific equipment in the equipment-to-medical procedure master 206, but that medical procedure is not listed on the receipt, the medical expenses for that specific equipment are subject to proportional allocation. Furthermore, if there is a medical procedure associated with a specific equipment, but the illness name associated with that medical procedure does not exist in the receipt illness name information database, the medical expenses for that specific equipment are also subject to proportional allocation. Proportional allocation will be described later.

[0091] For example, as shown in FIG. 26, in a receipt containing a medical treatment with a medical treatment identification code of 70 (imaging diagnosis), the item "Patient Inhalation Set for Technetium-99m Gas Inhalation Device," whose first digit of the medical treatment identification code is 7, corresponds to special equipment. Since the medical treatment code for the "Patient Inhalation Set for Technetium-99m Gas Inhalation Device" is "730090000," all medical treatment codes for medical treatments associated with the specific equipment medical treatment code "730090000" are extracted by referring to the equipment-to-medical treatment master 206. For example, medical treatment codes including the medical treatment code "170024710" for scintigram (whole body) associated with the medical treatment code "730090000" are read out. Next, the medical treatment master 204 is referenced to extract the injury / illness classification code for the medical treatment associated with the extracted medical treatment code. For example, the illness / disease classification code "02010301025801" associated with the medical treatment content code "170027010" for scintigram (whole body) is extracted. Then, with reference to the illness / disease name master 222, all illness / disease codes having classification codes matching the extracted illness / disease classification code are extracted. For example, the illness / disease name code "2459001" for thyroiditis associated with the illness / disease name classification code "0201030102581" is extracted. Furthermore, with reference to the illness / disease name information database, a check is made to determine whether or not the illness / disease name code matching the illness / disease name code "2459001" extracted from the illness / disease name master 222 is included in the illness / disease name information database. At this time, since the illness / disease name master 222 does not include the illness / disease name code for thyroiditis matching the illness / disease code "2459001," the medical expenses for the "Patient Inhalation Set for Technetium-99m Gas Inhalation Device" are processed by proportional apportionment.

[0092] Furthermore, when one specific equipment is associated with multiple medical procedures in the equipment-to-medical procedure master 206, priority is given to the medical procedure among the multiple medical procedures for which there is an illness name associated with an illness name included in the medical receipt illness name information database. In other words, if there are medical procedures among the multiple medical procedures for which there is an illness name associated with an illness name included in the medical receipt illness name information database and medical procedures for which there is no illness name associated with an illness name included in the medical receipt illness name information database, it is preferable to allocate the medical expenses related to the specific equipment to the associated illness name.

[0093] <Processing for allocating initial consultation medical expenses by injury or illness> If the receipt includes an initial consultation fee, the allocation of the initial consultation fee to medical expenses will be carried out as follows:

[0094] When a receipt includes an item for initial consultation fees, the medical expense decomposition analysis device 100 does not use master information, but instead allocates the medical expenses for the initial consultation fees using information on the start date of treatment and the number of medical procedures in the information on the name of the illness or injury.

[0095] As shown in Figure 27, the illness or injury name listed on the receipt whose treatment start date is the same as the treatment date of the subject of the receipt will be processed as the allocation target for the initial consultation medical expenses.

[0096] For example, as shown in Figure 28, if a receipt includes an item for initial consultation, the first treatment start date in the same month and year is associated with the illness name whose treatment start date is closest to the beginning of the month. In this case, as shown in Figure 29, the medical expenses for the initial consultation fee are allocated to the illness name, diabetes.

[0097] For example, as shown in Figure 30, if a receipt includes an item for first visit and the number of first visits is two or more, the medical expenses are associated with the illness name on the treatment start date in order of the earliest start date among the treatment start dates in the same month and year as the treatment year and month. In this case, as shown in Figure 31, the medical expenses for the first first visit fee are allocated to the illness name of cold that corresponds to the treatment start date closest to the beginning of the month, and the medical expenses for the second first visit fee are allocated to the illness name of hyperlipidemia that corresponds to the treatment start date closest to the beginning of the month.

[0098] If a receipt indicates an initial consultation, but the month and year in which treatment began listed on the receipt does not correspond to the month and year of treatment for which the receipt is being made, the medical expenses for that initial consultation will be subject to proportional allocation.Proportional allocation will be discussed later.

[0099] <Processing to allocate medical expenses for management fees by injury or illness> If a management fee is listed on the receipt and the management fee is paid for the main illness, the allocation of the management fee to medical expenses will be done as follows: Management fees refer to medical procedures listed on the receipt that are predetermined to be processed as management fees for managing a specific illness or injury.

[0100] If the medical procedure listed on the receipt is determined to be a management fee, the medical expense decomposition analysis device 100 reads out information about the medical procedure that corresponds to the management fee, which is contained in the receipt summary information database. The medical procedure content code (medical procedure code) from the read out information is compared with the medical procedure code in the medical procedure master 204, and the illness / injury classification code corresponding to the matching medical procedure code is extracted from the medical procedure master 204. Furthermore, the illness / injury classification code extracted from the medical procedure master 204 is compared with the classification code in the illness / injury name master 222, and all illness / injury codes associated with the matching classification code are extracted.

[0101] Next, the receipt illness name information database is referenced to check whether or not it contains an illness name code that matches the illness name code extracted from the illness name master 222. If an illness name code that matches the illness name code extracted from the illness name master 222 is included, it is determined whether or not there is an illness name whose main illness name is 1 associated with the illness name of that illness name code. If there is an illness name whose main illness name is 1 (an illness name that corresponds to the main illness name), information associated with the illness name code of that illness name is read from the receipt illness name information database, and output as illness-related data in association with information on the medical treatment that corresponds to the management fee that was previously read from the receipt summary information database. If the injury / illness name code that matches the injury / illness name code extracted from the injury / illness name master 222 is not included, or if the injury / illness name code that matches the injury / illness name code extracted from the injury / illness name master 222 is included but only injury / illness names with a main illness name of 0 exist (only injury / illness names that do not correspond to the main illness name exist), the medical expenses corresponding to the medical treatment will be subject to proportional allocation. Proportional allocation will be described later.

[0102] <Processing to allocate medical expenses for medical treatment related to prescription medicines by injury or illness> When a medical receipt includes a description of a medical procedure related to a pharmaceutical product, the allocation of medical expenses for that medical procedure related to the pharmaceutical product is carried out as follows. Note that a medical procedure related to a pharmaceutical product refers to a medical procedure that is determined in advance to be treated as a medical procedure related to a pharmaceutical product among the medical treatment contents (medical procedures) listed on the receipt. Specifically, medical procedures related to pharmaceutical products include, for example, prescription fees, dispensing fees and basic dispensing fees that are listed on the medical fee statement (receipt) when a pharmaceutical product is prescribed in-hospital, and dispensing fees and basic dispensing fees that are listed on the dispensing fee statement (receipt).

[0103] Medical expenses for pharmaceutical treatment are allocated to medications listed in the dispensing fee statement (receipt) or in-hospital prescription, including medications listed in treatment identification numbers 20 to 28, injections listed in treatment identification numbers 30 to 39, and pharmaceutical fee deductions.

[0104] Figure 32 shows an example of injury / illness related data in which medical expenses for each medical procedure (medical procedure, medicine, specific equipment, etc.) are allocated by illness / injury name through the various processes described above. The process of allocating dispensing fees (hospitalization) and basic dispensing fees (hospitalization) for this example of injury / illness related data will be explained.

[0105] Dispensing fees (hospitalization) and basic dispensing fees (hospitalization) are medical expenses for medical procedures involving pharmaceuticals that cannot be directly associated with a specific illness or injury. Medical expenses for such medical procedures involving pharmaceuticals that cannot be directly associated with a specific illness or injury are distributed equally among the illness or injury names associated with pharmaceuticals. The medical procedure content code (drug code) for pharmaceutical-related medical procedures is expressed in the range of 600000000 to 699999999.

[0106] For example, if the dispensing fee (hospitalization) is 42 points and the basic dispensing fee (hospitalization) is 14 points, the total points will be 56 points. In the example of illness-related data shown in Figure 32, medications and their medical expenses are associated with two illnesses: hypertension and dyslipidemia (shown by the bold lines in Figure 32). Therefore, the total points for the dispensing fee (hospitalization) and the basic dispensing fee (hospitalization) are allocated equally to these two illnesses. In other words, the total points of 56 points for the dispensing fee (hospitalization) and the basic dispensing fee (hospitalization) are allocated equally to each of the two illnesses, 28 points each.

[0107] As a result, as shown in Figure 33, medical expenses related to dispensing fees (hospitalization) and basic dispensing fees (hospitalization) are associated with two illnesses in the drug-related items: hypertension and dyslipidemia (shown by the bold lines in Figure 33).

[0108] In addition, the points for the dispensing fee (hospitalization) and the basic dispensing fee (hospitalization) may be equally distributed between these two illnesses. In this case, the 42 points for the dispensing fee (hospitalization) are distributed equally to the two illnesses, 21 points each. Also, the 14 points for the basic dispensing fee (hospitalization) are distributed equally to the two illnesses, 7 points each.

[0109] <Proportional allocation processing> The following describes the allocation process for medical expenses for medical treatment that could not be allocated to an injury or illness name in any of the above-mentioned processes and was subject to proportional allocation processing.

[0110] Medical expenses for medical treatments that are subject to proportional allocation are allocated to the illness or injury names that are associated with some medical treatment in the various processes described above. First, medical expenses for illness or injury names that are associated with some medical treatment are tallied, and the point ratio for each illness or injury name is calculated. Next, the total medical expenses for medical treatments that are subject to proportional allocation are tallied. Then, the total medical expenses for medical treatments that are subject to proportional allocation are allocated to each illness or injury name according to the calculated point ratio for each illness or injury name.

[0111] For the example of injury / illness related data shown in Figure 33, the process of allocating medical expenses related to the general ward special hospitalization basic fee, general ward hospitalization period surcharge, and third-class regional surcharge will be explained.

[0112] The general ward special hospitalization basic fee, general ward hospitalization period surcharge, and third-class regional surcharge are medical expenses for medical treatment (treatment) that cannot be directly linked to a specific illness or injury. Therefore, these medical expenses are apportioned proportionally to the illness or injury that is already linked to some medical treatment.

[0113] For example, if the total of the general ward special hospitalization basic fee and general ward hospitalization period surcharge is 1,750 points and the third-class regional surcharge is 24 points, the total points will be 1,774 points.

[0114] In addition, in the example of illness-related data shown in Figure 33, medical expenses for some treatment have already been associated with three illnesses other than allergic rhinitis and obesity: hypertension, sleep apnea syndrome, and dyslipidemia. First, the total medical expenses points for these three illnesses are calculated. Hypertension is assigned a total of 348 points (= 40 + 280 + 56 / 2). Sleep apnea syndrome is assigned a total of 3,440 points (= 3,300 + 140). Dyslipidemia is assigned a total of 98 points (= 70 + 56 / 2). The total medical expenses points for the three illnesses are 3,886 points.

[0115] Next, calculate the medical expense point ratio for the three illnesses. For hypertension, divide the total points of 348 by the total points of 3,886 to get 9%. For sleep apnea syndrome, divide the total points of 3,440 by the total points of 3,886 to get 88%. For dyslipidemia, divide the total points of 98 by the total points of 3,886 to get 3%.

[0116] The total medical expenses for the treatments subject to proportional allocation are then allocated to each illness according to the calculated point ratio for each illness. For hypertension, 160 points are allocated, calculated by multiplying the total medical expenses for the treatments subject to proportional allocation (1,774 points) by a point ratio of 9%. For sleep apnea syndrome, 1561 points are allocated, calculated by multiplying the total medical expenses for the treatments subject to proportional allocation (1,774 points) by a point ratio of 88%. For dyslipidemia, 53 points are allocated, calculated by multiplying the total medical expenses for the treatments subject to proportional allocation (1,774 points) by a point ratio of 3%.

[0117] As a result, as shown in Figure 34, medical expenses related to the general ward special hospitalization basic fee, general ward hospitalization period surcharge, and third-class regional surcharge can be allocated proportionally to the illnesses of hypertension, sleep apnea syndrome, and dyslipidemia (shown by the bold lines in Figure 34).

[0118] <Medical cost decomposition analysis processing procedure> The procedure for medical expense decomposition analysis processing in the medical expense decomposition analysis device 100 will be described with reference to the flowchart of FIG.

[0119] In step S10, a process is performed to allocate medical expenses for medical procedures by illness or injury. Through the process in this step, the medical expense decomposition analysis device 100 functions as a medical procedure allocation means. The medical expense decomposition analysis device 100 performs a process to allocate medical expenses based on medical procedures listed on receipts by illness or injury.

[0120] In step S12, a process is performed to allocate medical expenses for pharmaceuticals by illness or injury. Through the process in this step, the medical expense decomposition analysis device 100 functions as a pharmaceutical allocation means. The medical expense decomposition analysis device 100 performs a process to allocate medical expenses for pharmaceuticals listed on the receipt by illness or injury.

[0121] In step S14, exception processing is performed for the process of allocating medical expenses for medical procedures by illness or injury. The processing in this step causes the medical expense decomposition analysis device 100 to function as a medical procedure allocation exception means. The medical expense decomposition analysis device 100 associates medical procedures that cannot be directly allocated to illness or injury with other medical procedures, thereby indirectly allocating medical expenses for medical procedures by illness or injury.

[0122] In step S16, exception handling is performed for the process of allocating medical expenses for pharmaceuticals to each illness or injury. The process in this step causes the medical expense decomposition analysis device 100 to function as a pharmaceutical allocation exception means. The medical expense decomposition analysis device 100 associates pharmaceuticals that cannot be directly allocated to each illness or injury with medical procedures, thereby indirectly allocating medical expenses for pharmaceuticals to each illness or injury.

[0123] In step S18, a process is performed to allocate individual medical expenses to each illness or injury. Through the process in this step, the medical expense decomposition analysis device 100 functions as an individual allocation means. The medical expense decomposition analysis device 100 performs a process to allocate medical expenses for medical treatment that cannot be directly allocated to an illness or injury name, such as medical expenses for specific equipment, initial consultation fees, and management fees, to the illness or injury name.

[0124] In step S20, a process is performed to allocate medical expenses for medical treatment related to pharmaceutical prescriptions by illness or injury. Through the process in this step, the medical expense decomposition analysis device 100 functions as a pharmaceutical-related allocation means. The medical expense decomposition analysis device 100 performs a process to allocate medical expenses for medical treatment related to pharmaceuticals by illness or injury.

[0125] In step S22, the medical expenses for the medical treatment are proportionally allocated to the names of injuries and illnesses. Through the processing in this step, the medical expense decomposition analysis device 100 functions as a proportional allocation means. The medical expense decomposition analysis device 100 performs a process of proportionally allocating the medical expenses for the medical treatment that could not be allocated to the names of injuries and illnesses in the above processing to each name of injury or illness.

[0126] As described above, according to this embodiment, medical expenses that were not allocated appropriately in the prior art can be allocated appropriately for each injury or illness.

[0127] [Configuration of the invention] [Configuration 1] A medical cost decomposition analysis device, a receipt injury / illness name information database that associates the injury / illness name written on the receipt with the injury / illness name code of the injury / illness name; a receipt summary information database that associates the medical treatment details written on the receipt, a medical treatment code indicating the medical treatment details, and medical expenses for the medical treatment details; Master information associating the injury / disease name code with the medical treatment content code; is accessible to A medical treatment content code indicating the medical treatment content is read from the medical receipt summary information database, With reference to the master information, read out the disease name code associated with the read out medical treatment content code; Select an injury / illness name code associated with the read-out injury / illness name code from among the injury / illness name codes included in the medical receipt injury / illness name information database, A process is performed to associate and output the illness name of the illness name code selected in the receipt illness name information database with the medical expenses associated with the medical treatment content code read out in the receipt summary information database; A medical expense decomposition analysis device characterized by allocating medical expenses for medical expenses for unassociated medical expenses at a predetermined ratio to the illness or injury names associated with the medical expenses when there is medical treatment that is not associated with any of the illness or injury name codes included in the prescription illness or injury name information database by referring to the master information. [Configuration 2] The medical expense decomposition analysis device according to configuration 1, A medical expense decomposition analysis device characterized in that the specified ratio is the ratio of medical expenses for each illness or injury name obtained by allocating the medical expenses for treatment associated with any illness or injury name out of the total medical expenses in the prescription summary information database to each illness or injury name. [Configuration 3] The medical expense decomposition analysis device according to configuration 1 or 2, A medical expense decomposition analysis device characterized in that, if the medical treatment details contained in the prescription summary information database are specified medical treatment details, the medical expenses of the medical treatment details, including the names of suspected injuries or illnesses, are associated with the specified medical treatment details. [Configuration 4] The medical expense decomposition analysis device according to configuration 3, The medical expense decomposition analysis device is characterized in that the predetermined medical treatment content is content related to one of an initial consultation, an examination, and an imaging diagnosis. [Configuration 5] The medical expense decomposition analysis device according to configuration 1 or 2, A medical expense decomposition analysis device characterized by associating the medical expenses for a specified medical treatment with the name of an injury or illness based on the start date of treatment for the injury or illness and the number of times the initial consultation fee is calculated. [Configuration 6] The medical expense decomposition analysis device according to configuration 5, The medical expense decomposition analysis device is characterized in that the predetermined medical treatment content is content related to an initial consultation. [Configuration 7] The medical expense decomposition analysis device according to configuration 1 or 2, A medical expense decomposition analysis device characterized in that, when the medical treatment details contained in the prescription summary information database are specified medical treatment details, the medical expenses of the medical treatment details are associated only with the name of the main illness or injury. [Configuration 8] The medical expense decomposition analysis device according to configuration 7, The medical expense decomposition analysis device is characterized in that the predetermined medical treatment content is content related to medical management. [Configuration 9] The medical expense decomposition analysis device according to any one of configurations 1 to 8, A medical expense decomposition analysis device characterized by changing the order of the process of associating medical expenses with names of illnesses and injuries for each medical treatment identification of the medical treatment content included in the prescription summary information database. [Configuration 10] A medical cost decomposition analysis program, a receipt injury / illness name information database that associates the injury / illness name written on the receipt with the injury / illness name code of the injury / illness name; a receipt summary information database that associates the medical treatment details written on the receipt, a medical treatment code indicating the medical treatment details, and medical expenses for the medical treatment details; Master information associating the injury / disease name code with the medical treatment content code; On a computer that has access to A medical treatment content code indicating the medical treatment content is read from the medical receipt summary information database, With reference to the master information, read out the disease name code associated with the read out medical treatment content code; Select an injury / illness name code associated with the read-out injury / illness name code from among the injury / illness name codes included in the medical receipt injury / illness name information database, executes a process of associating and outputting the illness name of the illness name code selected in the receipt illness name information database with the medical expenses associated with the medical treatment content code read out in the receipt summary information database; A medical expense decomposition analysis program characterized by executing a process that, by referring to the master information, if there is a medical treatment that is not associated with any of the illness or injury name codes included in the prescription illness or injury name information database, allocates the medical expenses of the unassociated medical treatment at a predetermined ratio to the illness or injury name associated with the medical expenses. [Configuration 11] A medical cost decomposition analysis method, comprising: a receipt injury / illness name information database that associates the injury / illness name written on the receipt with the injury / illness name code of the injury / illness name; a receipt summary information database that associates the medical treatment details written on the receipt, a medical treatment code indicating the medical treatment details, and medical expenses for the medical treatment details; Master information associating the injury / disease name code with the medical treatment content code; On a computer that has access to A medical treatment content code indicating the medical treatment content is read from the medical receipt summary information database, With reference to the master information, read out the disease name code associated with the read out medical treatment content code; Select an injury / illness name code associated with the read-out injury / illness name code from among the injury / illness name codes included in the medical receipt injury / illness name information database, executes a process of associating and outputting the illness name of the illness name code selected in the receipt illness name information database with the medical expenses associated with the medical treatment content code read out in the receipt summary information database; A medical expense decomposition analysis method characterized by executing a process in which, by referring to the master information, if there is a medical treatment that is not associated with any of the illness or injury name codes included in the prescription illness or injury name information database, the medical expenses of the unassociated medical treatment are allocated at a predetermined ratio to the illness or injury names associated with the medical expenses. [Explanation of symbols]

[0128] 10 Processing unit, 12 Memory unit, 14 Input unit, 16 Output unit, 18 Communication unit, 100 Medical cost decomposition analysis device, 102 Information and communication network, 200 Basic medical procedure master, 202 Treatment-to-treatment master, 204 Medical procedure master, 206 Equipment-to-medical procedure master, 220 Basic injury / illness name master, 222 Injury / illness name master, 240 Basic drug master, 242 Symptom master, 244 Drug master, 246 Drug-to-treatment master.

Claims

1. A medical cost decomposition analysis device, a receipt injury / illness name information database that associates the injury / illness name written on the receipt with the injury / illness name code of the injury / illness name; a receipt summary information database that associates the medical treatment details written on the receipt, a medical treatment code indicating the medical treatment details, and medical expenses for the medical treatment details; Master information associating the injury / disease name code with the medical treatment content code; is accessible to A medical treatment content code indicating the medical treatment content is read from the medical receipt summary information database, With reference to the master information, read out the disease name code associated with the read out medical treatment content code; Select an illness name associated with the read illness name code from among the illness name codes included in the medical receipt illness name information database, An output process is performed to associate and output the disease name selected in the receipt disease name information database with the medical expenses associated with the medical treatment content code read out in the receipt summary information database; A medical expense decomposition analysis device characterized in that, when there is a medical treatment content code in the master information that is not associated with any of the illness or injury name codes contained in the receipt illness or injury name information database, and the illness or injury name code associated with the medical treatment content code read from the receipt summary information database cannot be read, the output process allocates medical expenses for the medical treatment content corresponding to the unassociated medical treatment content code contained in the receipt summary information database at a predetermined ratio to the illness or injury name associated with the medical expenses.

2. The medical expense decomposition analysis device according to claim 1, A medical expense decomposition analysis device characterized in that the specified ratio is the ratio of medical expenses for each illness or injury name obtained by allocating the medical expenses for treatment associated with any illness or injury name out of the total medical expenses in the prescription summary information database to each illness or injury name.

3. 3. The medical expense decomposition analysis device according to claim 1, A medical expense decomposition analysis device characterized in that, if the medical treatment details contained in the prescription summary information database are specified medical treatment details, the medical expenses of the medical treatment details, including the names of suspected injuries or illnesses, are associated with the specified medical treatment details.

4. The medical expense decomposition analysis device according to claim 3, The medical expense decomposition analysis device is characterized in that the predetermined medical treatment content is content related to one of an initial consultation, an examination, and an imaging diagnosis.

5. 3. The medical expense decomposition analysis device according to claim 1, A medical expense decomposition analysis device characterized by associating the medical expenses for a specified medical treatment with the name of an injury or illness based on the start date of treatment for the injury or illness and the number of times the initial consultation fee is calculated.

6. The medical expense decomposition analysis device according to claim 5, The medical expense decomposition analysis device is characterized in that the predetermined medical treatment content is content related to an initial consultation.

7. 3. The medical expense decomposition analysis device according to claim 1, A medical expense decomposition analysis device characterized in that, when the medical treatment details contained in the prescription summary information database are specified medical treatment details, the medical expenses of the medical treatment details are associated only with the name of the main illness or injury.

8. The medical expense decomposition analysis device according to claim 7, The medical expense decomposition analysis device is characterized in that the predetermined medical treatment content is content related to medical management.

9. The medical expense decomposition analysis device according to claim 1, A medical expense decomposition analysis device characterized by changing the order of the process of associating medical expenses with names of illnesses and injuries for each medical treatment identification of the medical treatment content included in the prescription summary information database.

10. A medical cost decomposition analysis program, a receipt injury / illness name information database that associates the injury / illness name written on the receipt with the injury / illness name code of the injury / illness name; a receipt summary information database that associates the medical treatment details written on the receipt, a medical treatment code indicating the medical treatment details, and medical expenses for the medical treatment details; Master information associating the injury / disease name code with the medical treatment content code; On a computer that has access to A medical treatment content code indicating the medical treatment content is read from the medical receipt summary information database, With reference to the master information, read out the disease name code associated with the read out medical treatment content code; Select an illness name associated with the read illness name code from among the illness name codes included in the medical receipt illness name information database, Execute an output process to associate and output the disease name selected in the receipt disease name information database with the medical expenses associated with the medical treatment content code read out in the receipt summary information database; A medical expense decomposition analysis program characterized by executing a process in which, when the master information contains a medical treatment content code that is not associated with any of the illness or injury name codes included in the receipt illness or injury name information database and the illness or injury name code associated with the medical treatment content code read from the receipt summary information database cannot be read, the output process allocates medical expenses for the medical treatment content corresponding to the unassociated medical treatment content code at a predetermined ratio to the illness or injury name associated with the medical expenses.

11. A medical cost decomposition analysis method, comprising: a receipt injury / illness name information database that associates the injury / illness name written on the receipt with the injury / illness name code of the injury / illness name; a receipt summary information database that associates the medical treatment details written on the receipt, a medical treatment code indicating the medical treatment details, and medical expenses for the medical treatment details; Master information associating the injury / disease name code with the medical treatment content code; On a computer that has access to A medical treatment content code indicating the medical treatment content is read from the medical receipt summary information database, With reference to the master information, read out the disease name code associated with the read out medical treatment content code; Select an illness name associated with the read illness name code from among the illness name codes included in the medical receipt illness name information database, Execute an output process to associate and output the disease name selected in the receipt disease name information database with the medical expenses associated with the medical treatment content code read out in the receipt summary information database; A medical expense decomposition analysis method characterized in that, when there is a medical treatment content code in the master information that is not associated with any of the illness or injury name codes contained in the receipt illness or injury name information database, and the illness or injury name code associated with the medical treatment content code read from the receipt summary information database cannot be read, the output process executes a process to allocate medical expenses for the medical treatment content corresponding to the unassociated medical treatment content code contained in the receipt summary information database at a predetermined ratio to the illness or injury name associated with the medical expenses.

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