The invention discloses a medical insurance
cost prediction and optimization method based on
big data analysis, and belongs to the technical field of medical
data processing. The method comprises the following steps: constructing a multi-
source data acquisition module, and integrating data of an HIS
system, a medical insurance platform and wearable equipment by using an FHIR interface and a block chain; a BERT-BiLSTM-CRF model is adopted to fuse multi-
modal data, a dynamic model group containing Transform
anomaly detection and LSTM-ARIMA
time sequence prediction is established, and the prediction error rate is reduced to 12% (reduced by 28% compared with that of a traditional method); a multi-objective
optimization system is designed,
medical quality and
cost control are balanced based on an improved NSGA-II
algorithm, the cost of a single
disease is reduced by 18%-25%, and the
quality standard reaching rate exceeds 95%; a
hybrid cloud and
homomorphic encryption module is deployed, and the data leakage risk is reduced by 90%; a policy sandbox
system is constructed, medical insurance policy
simulation deduction is supported, and the
response time is shortened to 72 hours. According to the invention, the problems of data islands, low prediction precision and privacy risks are solved, and the whole-process
intelligent management and control of medical insurance fees is realized.