CN113921124A

CN113921124A - Medical expense management method and system

Info

Publication number: CN113921124A
Application number: CN202111190031.4A
Authority: CN
Inventors: 不公告发明人
Original assignee: Individual
Current assignee: Individual
Priority date: 2021-10-12
Filing date: 2021-10-12
Publication date: 2022-01-11

Abstract

The invention discloses a medical expense management method and a system, wherein the medical expense management method comprises the following steps: establishing a medical expense management database; acquiring patient information, disease information and medical information; patients were subjected to DRG/DIP grouping; subdividing each group into one or more subgroups, classifying patients into appropriate subgroups and obtaining cost management objectives; and decomposing the treatment scheme, comprehensively analyzing the treatment rationality and the necessity of each sub-item, and providing an analysis result of the cost control of the treatment scheme. The medical expense management system comprises: the system comprises a database module, an information acquisition module and an intelligent analysis module. According to the medical expense management method and system, the medical expense management is carried out based on the DRG/DIP, the treatment intensity of each item or each item of a treatment scheme is adjusted, the medical expense can be accurately controlled, the medical resources are reasonably distributed, the diagnosis and treatment behaviors are standardized, the excessive treatment is avoided, and the economic burden of a patient is reduced.

Description

Medical expense management method and system

Technical Field

The invention relates to the technical field of intelligent medical information processing, in particular to a medical expense management method and system.

Background

With the continuous improvement of living standard, the demand of people for medical treatment is greatly increased, and the medical cost is also greatly increased. In order to manage medical expenses more effectively, the diagnosis and treatment behaviors of medical institutions are more standard, medical expenses are compensated reasonably, and medical technology is fully developed; patients enjoy high-quality medical services, excessive treatment is avoided, and economic burden is reduced; medical insurance realizes that the amount of money is not overdrawn, and the availability factor is more high-efficient, and is more accurate to medical institution and medical insurance patient's management, and the settlement mode is also more convenient simultaneously.

The Diagnosis Related Group (DRG) is an important tool for measuring the efficiency of medical service quality and making medical insurance payments. The DRG classifies patients into a plurality of diagnosis groups for management according to factors such as age, disease diagnosis, complications, treatment modes, disease severity, outcome and resource consumption, and the like, and insurance institutions no longer pay the medical institutions according to the actual cost of the patients in hospital but pay according to the payment standard of diagnosis related groups to which the cases enter. DIP refers to the total budget of a regional point method and the payment according to the disease category value, and solves the problem of medical insurance payment by a fuzzy mathematical method, and comprises the payment according to the disease category and the total budget management. The medical expense management and control relates to effective treatment of diseases, reasonable distribution of medical resources, safety and health of patients and the like, and is the key for guaranteeing medical quality, controlling unreasonable medical expense and maintaining rights and interests of patients.

The goal expected to be reached by the medical insurance application DRG/DIP payment is to achieve medical-insurance-patient win-win. The medical insurance fund is not overburdened through the DRG/DIP payment, the use efficiency is higher, and the management of medical institutions and medical insurance patients is more accurate; the diagnosis and treatment behaviors in the hospital aspect are more standard, the medical expenditure is reasonably compensated, and the medical technology is fully developed; the patients enjoy high-quality medical service, the economic burden is reduced, and the settlement mode is more convenient.

The existing medical expense management system generally determines a total expense target aiming at DRG/DIP expense management, and lacks a control means for each item expense in a specific diagnosis and treatment process, and because the personal actual condition, the disease condition, the severity and whether complications exist or not of a patient are different, the treatment scheme and expense are also different, and expense control is difficult to perform.

Therefore, there is an urgent need for a method and system for managing medical expenses, which performs medical expense management based on DRG, comprehensively analyzes the necessity of each item of a treatment plan in terms of applicability, safety, effectiveness, economy, comfort, etc., removes or reduces unnecessary treatments in the treatment plan, increases or changes treatments with high necessity in the treatment plan, can precisely manage and control medical expenses, reasonably allocate medical resources, standardize diagnosis and treatment behaviors, avoid over-treatment, and reduce economic burden of patients.

Disclosure of Invention

The main purposes of the invention are: aiming at the problems of unreasonable medical resource distribution and irregular treatment behavior caused by lack of control means of various project expenses in the specific DRG/DIP diagnosis and treatment process of a medical expense management system, a medical expense management method and a medical expense management system are provided.

In order to achieve the above object, the present invention provides a medical expense management method, including:

establishing a medical expense management database, wherein the medical expense management database comprises relevant rules of medical expense management;

acquiring patient information, disease information and medical information;

patients were subjected to DRG/DIP grouping;

according to different crowd information, disease information and treatment schemes of patients, subdividing each group into one or more subgroups, dividing the patients into proper subgroups and obtaining cost management targets;

and decomposing the treatment scheme, comprehensively analyzing the treatment rationality and the necessity of each sub-item, and providing an analysis result of the cost control of the treatment scheme.

A method of medical expense management as described above, the sub-items of the treatment plan comprising: at least one of pharmacotherapy/medical device therapy/examination/surgery/chemotherapy/radiotherapy/phototherapy/thermotherapy/magnetotherapy/electrotherapy/magnetotherapy/phonotherapy/immunotherapy/gene therapy/manipulation/physiotherapy/dietotherapy/rehabilitation/exercise/health care/psychological intervention/nutritional support/chinese medical therapy.

A method of medical expense management as described above, the sub-items of the treatment plan comprising: at least one of a diagnostic phase treatment/a pre-operative preparation phase treatment/a perioperative phase treatment/a post-operative observation phase treatment/a convalescent phase treatment.

A method for medical expense management as described above, further comprising deriving a medical expense management model under different DRG/DIP groups or subgroups based on manual settings, big data analysis or evidence-based optimization, the medical expense management model comprising expense target decomposition, expense proportion and category detail templates, and treatment plan templates.

A method of medical expense management as above, the method further comprising: setting at least one analysis item of applicability, safety, effectiveness, comfort and economy for each sub-item of the treatment scheme, respectively setting corresponding levels/scores for analysis results of each sub-item of the treatment scheme in different analysis items, and calculating comprehensive levels/scores of treatment rationality and necessity of different sub-items according to the levels/scores corresponding to the sub-items in each analysis item and a medical expense management model when performing comprehensive analysis of treatment rationality and necessity of the treatment scheme sub-items.

According to the medical expense management method, the analysis result of the treatment scheme expense management can be used for expense management and audit of the treatment scheme, expense management and comment of the treatment scheme, adjustment suggestion of the treatment scheme expense management and recommendation of the treatment scheme suitable for expense management.

The medical expense management method as described above, the relevant rules of the medical expense management include: at least one of rules related to medical insurance/welfare, rules related to economic regulation, rules related to applicability, rules related to contraindications, rules related to caution/attention, rules related to interaction, rules related to allergies, rules related to time, rules related to method of development/method of use, rules related to usage, rules related to adverse reactions, rules related to preparation/protective measures, rules related to suitability/comfort/compliance, and rules related to administrative management.

The method for managing medical expenses further comprises a patient personal information database, wherein the patient personal information database comprises the relevant information of the patient, and the relevant information of the patient is provided or supplemented.

The medical expense management method further comprises a medical insurance settlement function, wherein the medical insurance settlement function comprises uploading data to a medical insurance settlement system and acquiring a medical insurance settlement result.

The present invention also provides a medical expense management system, including:

the database module is used for storing a medical expense management database, and the medical expense management database comprises related rules of medical expense management;

the information acquisition module is used for acquiring patient information, disease information and medical information;

the intelligent analysis module is used for dividing the patient into DRG/DIP groups, subdividing each group into one or more subgroups according to different crowd information and disease information of the patient and a treatment scheme, dividing the patient into proper subgroups and obtaining a cost management target, decomposing the treatment scheme, comprehensively analyzing the treatment rationality and the necessity of each sub-item and providing an analysis result of treatment scheme cost control.

The invention relates to a medical expense management method and a system, wherein the medical expense management method comprises the following steps: establishing a medical expense management database; acquiring patient information, disease information and medical information; patients were subjected to DRG/DIP grouping; subdividing each group into one or more subgroups, classifying patients into appropriate subgroups and obtaining cost management objectives; and decomposing the treatment scheme, comprehensively analyzing the treatment rationality and the necessity of each sub-item, and providing an analysis result of the cost control of the treatment scheme. The medical expense management system comprises: the system comprises a database module, an information acquisition module and an intelligent analysis module. According to the medical expense management method and system, the medical expense management is carried out based on the DRG/DIP, the rationality and the necessity of each item of the treatment scheme are comprehensively analyzed from the aspects of applicability, safety, effectiveness, economy, comfort and the like, the treatment intensity of each item or each item of the treatment scheme is adjusted, the medical expense can be accurately controlled, the medical resources are reasonably distributed, the diagnosis and treatment behaviors are standardized, the excessive treatment is avoided, and the economic burden of a patient is reduced.

Drawings

FIG. 1 is a flow chart of a medical expense management method according to the present invention.

Fig. 2 is a system block diagram of a medical expense management system according to the present invention.

Detailed Description

To further explain the technical means and effects of the present invention adopted to achieve the intended purpose, the following detailed description of the embodiments of the present invention is provided in conjunction with the accompanying drawings and examples.

A first embodiment of the present invention is described with reference to fig. 1. FIG. 1 is a flow chart of a medical expense management method according to the present invention. As shown in the drawings, the medical expense management method of the present invention includes:

step 1: and establishing a medical expense management database.

The medical expense management database comprises related rules of medical expense management, specifically comprises analysis/application/use rules and data and other contents of various items related to the medical expense management, and also can comprise various related element attributes and values/ranges/calculation methods/sources/limiting conditions/exclusion conditions of the various element attributes, and interrelations/interactions/interconversions/rules/calculation methods among various/various groups/various element attributes.

The medical expense management database of the invention is based on various clinical treatment paths, guidelines, related price regulations, related price catalogues, related bidding results, related price policies, related insurance payment terms, related insurance payment agreements, related bidding results, related purchasing catalogues, drug descriptions, prescription sets, pharmacopoeias, expert consensus, conference disciplines and consensus within the conjunctions/hospitals/departments, industry norms, textbooks, treatises, writings, inventions, scientific inferences, experimental reports, test reports, data analysis reports, test reports, examination and approval documents, related regulations, related guidance opinions, related policies, related regimes, related catalogues, related literature data, related doctors/nurses/pharmacists/nursing staff/users/salesmen's use evaluation/use results/use monitoring reports/safety reports, Other literature data, other research results with professionalism/authority, a evidence-based medical method, or probability speculation based on existing data, a database established by sources such as various weights, various levels, various orders and the like needing to be set manually, a database established based on information reforming, information analysis and big data analysis, a database established through artificial intelligence deep learning, a database obtained through data mining analysis, rules and indexes manually set through data statistical analysis/artificial intelligence deep learning, and therefore the method has guidance in the actual use process. The medical expense management database may be a database created by combining the above methods. The database can be updated according to versions or can be updated in real time according to actual data. The medical expense management database can be a relational database or a non-relational database; can be a table database or a graph database; the related data may be structured data or unstructured data. The data form of the medical expense management database may be text, chart, audio, video, or other suitable form.

Relevant rules for medical expense management may include: at least one of rules related to medical insurance/welfare, rules related to economic regulation, rules related to applicability, rules related to contraindications, rules related to caution/attention, rules related to interaction, rules related to allergies, rules related to time, rules related to method of development/method of use, rules related to usage, rules related to adverse reactions, rules related to preparation/protective measures, rules related to suitability/comfort/compliance, rules related to administrative management, and other rules related to medical expense management may be included.

The relevant rules for medical expense management may involve elements including: information of each element of basic information, crowd information, heredity related information, disease information, medical history information, medication history information, medical equipment use history information, operation items, physiological development information, marriage and education information, physiological conditions, psychological/intellectual conditions, life/work/study/sport/entertainment information, environmental information, medicine/medical equipment/health products/cosmetics related information, medical insurance related information, medical institution information and the like of a patient are related to the reasonable and compliant use of the medicine. The crowd information may include specific crowd information such as specific age, gender, development status, marital status, fertility status, work status, learning status, exercise status, life status, physiological status, psychological status, and genetic status. The genetically related information includes: genetic information, genetic medical history, family medical history, and the like. The disease information includes: disease, diagnosis, symptom type, symptom, index, pulse condition, tongue diagnosis, etc. The medical history information includes medical history, surgical history, radiotherapy history, chemotherapy history, psychotherapy history, physical therapy history, immunotherapy history, gene therapy history and the like. The medication history information includes: medication history, drug efficacy, adverse drug reactions, drug allergy history, drug tolerance and the like. The medical instrument use history information includes: the history of the medical appliance, the curative effect of the medical appliance, the adverse reaction of the medical appliance, the tolerance condition of the medical appliance and the like. The operation items include operation, examination, test, detection, operation, health promotion, rehabilitation, psychotherapy, radiotherapy, chemotherapy, physiotherapy, thermotherapy, phototherapy, magnetotherapy, electrotherapy, cryotherapy, electromagnetic therapy, phonotherapy, immunotherapy, gene therapy, weight reduction, body building, shaping, and skin caring. The physiological development information includes: growth and development conditions, physiological stages, fertility and the like. The marriage and childbirth information comprises marriage history, birth history, sexual life and the like. The physiological conditions include: physical performance, nutritional status, hearing, vision, taste, smell, touch, respiration, motor coordination, digestion, absorption, excretion, and levels of related abilities. Psychological/intellectual status includes: psychological disorders, mood, feeling, intelligence, attention, memory, perception, communication ability, expression ability, and the like. Life/work/learning/sports/entertainment information includes: diet, work and rest, sleep, work, study, entertainment, sports, etc. The environment information includes: temperature, humidity, air pressure, season, altitude, air quality, terrain, topography, oxygen content, light, ultraviolet light, radiation, electromagnetic waves, noise, epidemics, vegetation and other information. The drug/medical device/health product/cosmetic related information includes: medicine use, medical instrument use, health product use, cosmetics use and other related information. The medical insurance-related information includes medical welfare, medical insurance, business insurance, and the like. The medical institution information includes medical institution level, specialty, attribute, region, department, etc.

The rules in the medical expense management database also comprise the condition that each element needs to be combined to be effective, the related rules can be defined by the comprehensive conditions after the elements are combined according to multi-level and/or non-relationship and the relationship defined by the related formula, and the related rules can also comprise the condition that the related rules are related to the time dimension.

Relevant rules for medical insurance/welfare and their elements may include: the treatment plan and whether each sub-item belongs to the medical welfare/medical insurance or business insurance scope and condition, object, ratio, calculation method, amount and the like, and also can include the limit of the relevant constraint terms hospital/department/doctor/nurse and the like, and also can include information of price, single expense, single daily expense, single course expense, total expense and the like. The treatment plan and whether each sub-item falls within the medical welfare/medical insurance or business insurance scope and conditions include: people, diagnoses, symptoms, symptom types, operations, examinations, operations, projects, rehabilitation, psychotherapy, physical therapy, health care, nursing, accompanying, areas, medical institutions, departments, doctors, drugstores, examination centers, physical examination centers, treatment centers, rehabilitation centers, dosage of methods, and the like, and combinations thereof. And relevant constraint terms such as violation behaviors, inspection modes, violation punishment measures and the like.

The rules and elements of economic regulation may include: the treatment scheme and the cost limits of the single cost, the single daily cost, the single treatment course cost, the total cost, the average times, the average platform/operation, the average person, the average day and the average month of each sub-project, the cost limits of different hospitals/departments/doctors/nurses, the cost limits of different diseases/different schemes/different projects/patients and the like, and the economic related indexes of the treatment scheme can be preset according to the actual economic capacity and budget of the patient.

Relevant rules for applicability and elements thereof may include: the necessity, the level, the degree, the sequencing, the effectiveness of the treatment scheme and the applicability of each sub-item, the applicability evaluation of patients/operators/doctors/pharmacists/nurses/caregivers, the reasonability and the compliance of applicable groups, the reasonability and the compliance of applicable purposes, the reasonability and the compliance of indications/applicable conditions, various factors influencing the applicability, the relationship between the factors and the applicability and the like.

The relevant rules for contraindications and their elements may include: the reason for the contraindication of the treatment scheme and the sub-items, the relationship between each factor and the contraindication which may affect the contraindication, the guidance and prompt/warning information of the relevant patient/operator/doctor/nurse/pharmacist/caregiver, the result of the contraindication, the level, degree, sequence and occurrence rate of the corresponding contraindication, the relative evaluation of the contraindication of the patient/operator/doctor/pharmacist/nurse/caregiver, the discovery and remedy of the contraindication in the above situation, and the like.

Relevant rules that require caution/attention and their elements may include: the reason for the cautiousness or attention of the treatment scheme and the sub-items, the relationship between each factor possibly influencing the cautiousness or attention and the cautiousness or the cautiousness, the guidance/warning information of the relevant patient/operator/doctor/nurse/pharmacist/caregiver, the grade, degree, sequence, probability of occurrence, the risk degree of cautiousness/attention, the evaluation of the cautiousness or the attention of the patient/operator/doctor/pharmacist/nurse/caregiver, the discovery and the remedy of the relevant result of the situation, and the like.

The rule relating to interaction means that there is an interaction/interaction between the sub-items of the treatment protocol or that there is an interaction/interaction between the treatment protocol and the sub-items with other drugs, surgery, medical examinations and examinations, diet, health products, cosmetics, medical devices, operations, etc., i.e. if there is an interaction/interaction, the treatment protocol and the sub-items should be avoided or carefully selected and care and rescue preparation should be taken during the process.

The relevant rules of interaction and their elements may include: the therapeutic scheme and each sub-item can interact/interact with other drug/medical apparatus/examination/operation/chemotherapy/radiotherapy/phototherapy/thermotherapy/magnetotherapy/electrotherapy/electromagnetic therapy/phonotherapy/immunotherapy/gene therapy/operation/physiotherapy/rehabilitation/health care/sport/psychologic intervention/health care food/cosmetic/diet or other factors or items when simultaneously existing/performed, and the therapeutic scheme and each sub-item can interact/interact with related drug/medical apparatus/examination/operation/chemotherapy/radiotherapy/phototherapy/thermotherapy/magnetotherapy/electrotherapy/magnetotherapy/phonotherapy/immunotherapy/gene therapy/operation/physiotherapy/rehabilitation/health care/transportation The influence of factors such as the respective site/route/method/interactional time/dose/time of action/psychological intervention/nutraceutical/health food/cosmetic/diet on the above-mentioned interaction/interaction, and the influence of other factors that may influence the above-mentioned interaction/interaction on the interaction may be caused.

Other factors that may have an effect on the above interactions/interactions include: patient genetic-related factors, lifestyle-related factors, diet-related factors, disease/treatment history-related factors, family medical history, allergy factors, work/learning/exercise/activity-related factors, environment-related factors, physiological/psychological/learning/sleep/exercise/emotion/metabolism/vision/hearing/intelligence/attention/appetite/immunity/growth/development/memory/fertility etc. state/status/level factors, age-related factors, physiological function-related factors, fertility status-related factors, sexual life status-related factors, and other factors and items that may enhance/reduce/alter the above-mentioned interactions/interactions, and the specific way in which these factors and items affect the relevant interactions/interactions, the disease/treatment history-related factors, family medical history, allergy factors, work/learning/exercise/activity-related factors, environment-related factors, age-related factors, physiological function-related factors, fertility-related factors, sexual life status-related factors, and other factors and items that may enhance/interact with the relevant factors, Influence the result and degree of influence, etc.

The rules relating to interaction may further include: the reason for the interaction/interaction between the treatment plan and the sub-items, the guidance/warning information of the relevant patient/operator/doctor/nurse/pharmacist/caregiver, the possible consequences of the interaction/interaction, the level, degree, sequence, probability of occurrence, degree of danger/benefit of the interaction/interaction, the evaluation of the relevant interaction/interaction by the patient/operator/doctor/pharmacist/nurse/caregiver, the discovery and remedy of the interaction/interaction.

The relevant rules and elements of allergy may include the treatment regimen that may cause allergic reactions, the physicochemical properties and the principles/mechanisms of action of the various sub-items, and the specific elements include: the material comprises components, raw materials, electricity, magnetism, light, heat, radiation, irritation, size, weight, heavy metal, toxicity, smell, shape, specification, package, material, additive, preservative, antifreezing agent, consumable material and relevant information such as relevant concentration, content, strength, valence and the like.

The relevant rules for allergy may also include: the physical constitution, age, sex, height, weight, development related information, birth related information, sexual life related information, genetic related information of the patient, climate/air quality/humidity/season/temperature of the environment, disease/symptom/index/feeling/emotion of the patient, treatment history or treatment plan of the patient, family history/disease history/allergy history/genetic history/regional epidemic history/smoking history of the patient and the like which may possibly have allergy, working condition/learning condition/rest condition/exercise condition/nutritional condition/eating condition/work time/immunity condition of the patient, medicine/operation/chemotherapy/radiotherapy/phototherapy/thermotherapy/magnetotherapy/electrotherapy/magnetotherapy/phonotherapy/immunotherapy/gene therapy and the like The information of concern.

The relevant rules for allergy may also include: the possible manifestations and consequences of allergic reactions under different conditions, the reasons and mechanisms of allergic reactions, the relationship between various factors and allergic reactions that may affect allergic reactions, guidance/warning information of related patients/operators/doctors/nurses/pharmacists/caregivers, the grade, severity, ranking, occurrence probability of allergic reactions, the evaluation of related allergic reactions by patients/operators/doctors/pharmacists/nurses/caregivers, the discovery of related allergic reactions and remedial measures in the above situations, and the like. It is also possible to set the conditions under which the allergy test is to be performed, and if the condition of the patient meets the relevant conditions, the patient needs to go through the allergy test first and the result is negative before the patient can pass the allergy test.

The relevant rules of time and its elements may include: the treatment plan and the start time, duration, pause time, break time, progression period, progression frequency, treatment period, treatment interval, treatment course number, onset time, expiration time, end time, etc. of each sub-item. The correlation rules of time may be defined and stored in different time attribute types, and the time-related element attribute types include time element attributes related to natural rhythms such as: year, month, day/night, morning/noon/afternoon/evening/night, season, solar terms, lunar calendar year/month/day, etc.; the time element attributes associated with the time of day are: hours, minutes, hours, etc.; the time element attributes related to the personal work and rest life law are as follows: getting up, before/during/after meal, before sleep; time element attributes associated with a particular condition/symptom/index/psychological state/physiological state/sensation are as follows: body temperature above a certain value, pain, fatigue, vertigo, palpitation, nausea, creatinine clearance above a certain value, blood pressure below a certain value, heart rate above a certain value, emotional depression, feelings of fear, excitement, etc.; treatment-related time element attributes are as follows: one day before a certain examination, 3 hours after a certain operation, when changing a certain medicine, after a certain physical therapy project, etc.; temporal element attributes associated with the age/developmental stage of a patient are as follows: 2 weeks after birth, after eruption of deciduous teeth, after adolescent development, half a year after menopause, climacteric period, etc.; time element attributes associated with a patient's physiological cycle are as follows: first day of menstruation, etc.; time element attributes associated with patient fertility/sexual life are such as: 24 hours after the sexual intercourse of the couple, 3 months before the preparation of pregnancy, 24 weeks of pregnancy, 3 days after the birth, and the like; time element attributes related to patient work/activity/movement/learning are as follows: before sitting on the front of a car, before sitting on a boat, before high-altitude operation, after long-time reading and the like.

The time-related rules may further include: the factors which may affect the time and the relationship with the time may also include the interconversion relationship when the time needs to be interconverted with different time attribute types, and the calculation and interconversion relationship with the international standard time and the time in each time zone.

Relevant rules and elements thereof for developing methods/methods of use may include: the treatment protocol and the accepted or used route, site, time, distance, temperature, environment, condition, equipment/consumable, operation method, operator requirement, protection condition/protection measure, and related cautionary matters of each sub-item. The method can also comprise the following steps: the treatment plan and sub-items may be influenced by and influence results of treatment objectives, applicable population, corresponding indications/indications, corresponding health status evaluation items, corresponding environment, performance, dosage, patient drugs/medical instruments/healthcare products/diet/cosmetics/medical examination and inspection, patient work/study/exercise related information, patient sexual life/work and rest time/genetic information, and the like. It may also include consequences and associated remedial actions that may occur if the treatment plan and sub-items are not accepted or developed in the correct way.

Relevant rules for usage and its elements may include: the specification, package, dosage, quantity, intensity, frequency, wavelength, concentration, method, application range, duration, application area, etc. of the treatment plan and the related articles of each sub-project include project information required to be subjected to unit/data conversion, and can also include: the dosage may be influenced by and influence the purpose, applicable population, corresponding indication/indication, corresponding health status evaluation item, corresponding environment, performance, usage, patient drug/medical device/health product/diet/cosmetic/medical examination and inspection, patient work/study/exercise related information, patient sexual life/work time/genetic information, and the like. The method can also comprise the following steps: single dose/dose, single day or other time unit times/frequency, single day or other time unit dose/dose, total single treatment course, total treatment course times, total dose, and like information. It may also include consequences and associated remedial actions that may occur if the treatment regimen and sub-items are not received or developed in the correct amounts.

The relevant rules and elements of adverse reactions may include: the relationship between the treatment scheme and the methods/dosage/time/frequency/interval/protective measures of the sub-items and the adverse reactions possibly occurring, and the relationship between the factors possibly influencing the adverse reactions and the adverse reactions, can also comprise: symptoms/index signals/expression/feeling/severity/harm of adverse reactions, treatment of adverse reactions, a method for preventing adverse reactions, remedial measures after adverse reactions occur, and the like.

Relevant rules and their elements for preparation/protection measures may include: the physical, chemical, pharmaceutical, food, health, rehabilitation, biological, psychological intervention, humanistic, etc. types of preparation/protection/intervention/remedy/recovery related measures taken to avoid or reduce the risk and damage that may exist to the treatment regimen and the sub-items, and may also include the level of consequences and their risks that may occur if the preparation/protection measures were not taken according to the relevant rules, and the related remedial measures.

The relevant rules for suitability/comfort/compliance and elements thereof may include: comfort, convenience, difficulty, compliance difficulty, aesthetics, weight of wear, shape, size, volume, footprint, taste, odor, feel, temperature, hardness, irritation, portability, ease of storage, etc. of the treatment regimen and sub-items, as well as methods of adjusting suitability/comfort/compliance, including various ancillary conditions, ancillary measures, ancillary methods, ancillary operations, etc.

The relevant rules for suitability/comfort/compliance may also include: according to the conditions of the age, the sex, the physical condition, the sensitivity, the tolerance of electrical stimulation/magnetic field/pressure/pain, the taste preference, the motor ability, the physical strength, the work/study/motion/activity/travel rule and characteristic, the work and rest time, the aesthetic requirement, the study ability, the operation ability, the execution ability and the like of the patient, the weight and the combined calculation method of each item related to the suitability/comfort/compliance are set, and the target setting of the suitability/comfort/compliance of the patient is carried out. The suitability/comfort/compliance association rules may also include methods that require prompting the relevant physician, nurse, pharmacist, patient, caregiver to adjust the respective suitability/comfort/compliance when the target setting is not met.

Relevant rules and their elements for administration may include: regional-related regulations/requirements of treatment plans and sub-items, hospital-level-related regulations/requirements, hospital-property-related regulations/requirements, department-related regulations/requirements, doctor-related regulations/requirements, operator-related regulations/requirements, patient-related regulations/requirements, disease-type-related regulations/requirements, key-monitoring-related regulations/requirements, extraordinary-warning-related regulations/requirements, bidding results, price policy-related regulations/requirements, day-related regulations/requirements, amount-related regulations/requirements, DRGs (disease-related classification) -related regulations/requirements, clinical-path-related regulations/requirements, and the like. Patient-related prescriptions/requirements include: medical insurance, self-service charge, industrial injury, new agriculture and agriculture, dry insurance, chronic diseases, inconvenient movement, old people, disabled people and the like. The amount-related stipulations/requirements include: whether the system meets the related expense limit such as single disease type payment, total amount prepayment, expense proportion control, single variety purchasing/checking amount limit, type purchasing/checking amount limit and the like.

The medical expense management database may also include a grouping scheme that subdivides each DRG/DIP group into one or more sub-groups based on patient-specific demographic and disease information, and treatment regimens.

The medical expense management is carried out through DRG/DIP groups, each group can be subdivided under the DRG/DIP groups, each group can be subdivided into one or more layers of subgroups according to different crowd information and disease information and other related information, and the medical expense can be more finely managed through further grouping. The subdivided grouping scheme and the cost management target can be obtained according to manual setting, big data analysis or evidence-based optimization, and each sub-project and the related cost management target can be adjusted and optimized through the analysis of mass data in the using process.

For each group or subgroup, the treatment plan may be divided into a plurality of sub-items according to different types or stages, and a cost standard value, a cost proportion, a category detail template, and the like may be established for each sub-item. For example: sub-items of a treatment regimen can be divided by type: pharmacotherapy/medical device therapy/examination/surgery/chemotherapy/radiotherapy/phototherapy/thermotherapy/magnetotherapy/electrotherapy/magnetotherapy/phonotherapy/immunotherapy/gene therapy/operation/physiotherapy/dietotherapy/rehabilitation/exercise/health care/psychological intervention/nutritional support/chinese medicine therapy and the like. Sub-items of the treatment regime may also be divided into stages: diagnostic phase treatment/preoperative preparatory phase treatment/perioperative phase treatment/postoperative observation phase treatment/convalescent phase treatment, and the like.

The medical expense management database can also include a medical expense management model under different DRG/DIP groups or subgroups, including expense target decomposition, expense proportion and category detail templates, and treatment plan templates. The treatment plan template may be a specific treatment plan appropriate for each grouping/subgroup, including treatment method, content, treatment amount, time, procedure, precautions, and the like. The treatment plan template may be an overall treatment plan or may be a partial treatment plan, such as: according to different types or stages of sub-project specifics.

The medical expense management model can be obtained according to manual setting, big data analysis or evidence-based optimization, and each sub-item and related expense standards can be adjusted and optimized through mass data analysis in the using process.

Step 2: patient information, disease information, and medical information are obtained.

In the present invention, the patient information may include: patient basic information, genetic related information, family health related information such as family medical history, allergy history, regional epidemic history, medication history, surgical history, medical device use history, learning conditions, work conditions, exercise conditions, family conditions, living environment, hobbies, compliance conditions, tolerance conditions, medical insurance conditions, and physiological/psychological/learning/work/physical/sleep/exercise/emotional/metabolic/visual/hearing/mental/attention/diet/immune/growth development/memory/fertility conditions, and time of rest.

The disease information may include: indices, parameters, states or conditions of various physiological/psychological/learning/work/physical/sleep/exercise/mood/metabolism/vision/hearing/intelligence/attention/appetite/immunity/growth development/memory/fertility/genetic-related information, etc. of a patient; information obtained by inquiry, examination, detection, test, experiment, operation, evaluation and observation of diseases/symptoms/indexes and the like; information relating to the patient's growth/development/fertility/contraception/assisted reproduction/psychological/learning/work/exercise/entertainment/nutritional/caloric requirements, etc.; surgery/operation/examination/detection/monitoring/evaluation/analysis/prediction/physiotherapy/thermotherapy/phototherapy/magnetotherapy/electrotherapy/rehabilitation/healthcare/immunotherapy/gene therapy information of a patient; the medicine/medical instrument/health product/cosmetic of the patient, etc.

The medical information may include diagnostic information, treatment protocol information, medical condition information, and treatment outcome information, and may include other treatment-related information. The diagnostic information may include examination and test information related to diagnosis. The treatment plan information may include information related to pharmacotherapy/modality treatment/examination/surgery/chemotherapy/radiotherapy/phototherapy/thermotherapy/magnetotherapy/electrotherapy/magnetotherapy/phonotherapy/immunotherapy/gene therapy/operation/physiotherapy/dietotherapy/rehabilitation/exercise/health care/psychological intervention/nutritional support/chinese medicine therapy, etc. Medical condition information may include information on facility/equipment levels, health care personnel qualifications, drug catalogs, operating room/icu/ward environment of a medical facility. Treatment outcome information may include treatment efficacy, disease improvement, treatment safety, poor outcome, and the like.

The treatment plan is a plan for treating the patient, which is made by the doctor according to the specific condition of the patient under the condition of fully knowing the state of illness, medical history, diagnosis and examination results of the patient. Therapeutic protocol to achieve one or more therapeutic goals, one or more sub-items, which may be pharmacotherapeutic/medical device treatment/examination/surgery/chemotherapy/radiotherapy/thermotherapy/magnetotherapy/electrotherapy/electrophysiology/phonotherapy/immunotherapy/gene therapy/operation/physiotherapy/dietotherapy/rehabilitation/exercise/healthcare/psychological intervention/nutritional support/chinese medicine therapy, are combined according to a certain time, method, space, intensity and interrelationship between the sub-items. Sub-items may include the specific drugs/instruments/devices/materials/personnel/food/health food/actions/maneuvers/exercises and specific methods of use, volume/intensity of use, time of use, etc. involved. The therapeutic targets may be diagnosis/treatment/prevention of disease, improvement of indices, delaying aging, reduction of pain, reduction of risk, alteration of body function and morphology, etc.

The sources from which patient information, disease information, and medical information are obtained may be: patient-related symptoms, related indicators, feelings, states, physiological functions self-statement; the state and the requirement of the patient for learning, working, living, sports, etc. are self-describing; advice prescribed by medical staff; patient medical records, electronic medical records, diagnosis reports, examination results, inspection results, monitoring results, assessment reports; obtaining from a patient personal information database; information obtained by means of interrogation, examination, detection, testing, experimentation, surgery, assessment, evaluation, observation, etc.; preset time, season, time of day, interval, period and other information; the preset ways of monitoring the change of various physiological and pathological indexes; patient personal information databases, health profiles, family or family member health records, medical orders, medical records, drug calendars, prescriptions, electronic medical records, medical facility information systems, pharmacy/medical facility information systems, medical records, treatment records, assessment reports, consultation records, survey records, work-rest records/plans, dietary records/plans, medication records/plans, treatment records/plans, exercise records/plans, work records/plans, learning records/plans, rehabilitation records/plans, healthcare records/plans, examination/examination sheets, surgical plans/records, health management plans, billing sheets, clinical treatment paths, examination/examination results, surgical settings/records, genetic testing results, and may also be obtained from patient/doctor/nurse/caregiver use/prescription/recommendation records, the system can also be provided by various devices or systems such as wearable devices, sensors, electronic devices, electronic positioning systems, weather forecast systems, electronic temperature/humidity/air pressure detection devices, intelligent sound boxes, intelligent home systems, intelligent monitoring/monitoring systems, intelligent glasses, intelligent toilets, intelligent floors, intelligent scales, intelligent detection/analysis devices, electronic infusion systems, surgical robots, face recognition analysis, fingerprint recognition, voice recognition, gait recognition, positioning systems, social platforms and the like, or obtained by analyzing big data of information such as life, study, work, movement, travel, social contact, shopping, diet, work, entertainment and the like of a patient, or obtained by analyzing related information such as race/family/area/age/marital/birth and the like of the patient. The missing information may also be provided or refined by the patient/doctor/nurse/caregiver, or the information with high relevance may actively prompt the patient/doctor/nurse/caregiver to observe, monitor, check, query, analyze, confirm, record whether the relevant condition occurs or obtain the relevant index/performance/feeling/symptom/physiological change, the relevance is set or analyzed by data, the relevant elements are ranked or ordered according to the importance of the treatment scheme rationality and compliance in the aspects of effectiveness, safety, economy, suitability/comfort/compliance, etc., and the information with high importance may be set as the information that must be refined or cannot be processed in the next step. When the actual information of the relevant elements of the patient treatment scheme is obtained, the relevant medical advice information prescribed by specific medical personnel can be analyzed according to the personal information database of the medical personnel, so that the actual information of the relevant elements can be further accurately mastered. Assessment reports include physiological, psychological, economic, credit, athletic ability, and the like. The intelligent detection/analysis device includes: odor, image, sound, pulse condition, X-ray film, CT, nuclear magnetic, ultrasonic examination, brain wave, mass spectrum analyzer, tongue analysis, fundus examination, gastroscope, enteroscope, catheter, minimally invasive scope, heart rate, blood oxygen, blood pressure, blood sugar, blood fat, body temperature, blood examination, urine examination, stool examination, pulse measurement/analysis equipment, etc.

And step 3: patients were subjected to DRG/DIP grouping.

Patients were subjected to DRG/DIP grouping according to the criteria for DRG/DIP grouping. In the invention, the medical expense management method is mainly based on DRG/DIP to manage the medical expense, namely, cases are grouped according to factors such as age, disease diagnosis, complications, treatment modes, severity of symptoms, outcome and resource consumption of patients, and the specific target of expense management is determined by grouping.

And 4, step 4: each group is subdivided into one or more subgroups based on the patient's different population and disease information, and treatment regimens, and the patients are assigned to the appropriate subgroups and cost management objectives are obtained.

Since the differences in the various aspects of the patients within the grouped groups are still large according to the current DRG/DIP grouping, careful cost management for each group is not easy. For more elaborate setting of the cost management goals, fine management is performed, and each group can be subdivided into one or more subgroups according to different population information and disease information of patients, and treatment schemes. After one or more subgroups are subdivided, the characteristic differences of patients in the same subgroup in the aspects of age, disease diagnosis, complications, treatment modes, severity of diseases, outcome, resource consumption and the like of the patients are greatly reduced, and related cost management targets can be set for fine management.

The goal of the fee management can be the goal of the total fee, and also can be various fee indexes obtained according to manual setting or big data analysis, such as: DRG/DIP groups or subgroups average charge, average cost, average days, charge/cost of each sub-item, balance paid, drug proportion, duty ratio, consumption proportion, etc.

And 5: and decomposing the treatment scheme, comprehensively analyzing the treatment rationality and the necessity of each sub-item, and providing an analysis result of the cost control of the treatment scheme.

First, the treatment plan is decomposed to obtain one or more treatment plan sub-items, which can be classified into: pharmacotherapy/medical instrument therapy/examination/surgery/chemotherapy/radiotherapy/phototherapy/thermotherapy/magnetotherapy/electrotherapy/magnetotherapy/phonotherapy/immunotherapy/gene therapy/operation/physiotherapy/dietotherapy/rehabilitation/exercise/health care/psychological intervention/nutrition support/chinese medical therapy, etc., can also be divided into, according to stages: diagnostic phase treatment/preoperative preparatory phase treatment/perioperative phase treatment/postoperative observation phase treatment/convalescent phase treatment, and the like. Sub-items may include the specific drugs/instruments/devices/materials/personnel/food/health food/actions/maneuvers/exercises and specific methods of use, volume/intensity of use, time of use, etc. involved.

DRG/DIP divides patients into a plurality of diagnosis groups for management according to factors such as age, disease diagnosis, complications, treatment modes, disease severity, outcome and resource consumption, and insurance institutions no longer pay the medical institutions according to the actual cost of the patients in the hospital, but pay according to the payment standards of diagnosis related groups to which the cases enter. However, in the specific diagnosis and treatment process, the actual conditions, the disease conditions, the severity and the existence of complications of patients are different, so that the treatment schemes and the costs are different, and the diagnosis and treatment behaviors and the costs are not regulated and controlled.

The medical expense management method comprehensively analyzes the treatment rationality and the necessity of each sub-item of the treatment scheme, comprehensively analyzes the necessity of each sub-item of the treatment scheme from the aspects of applicability, safety, effectiveness, economy, comfort and the like, and analyzes the relationship between the rationality and the necessity of each sub-item of the treatment scheme and factors such as risk, cost, required cost and the like to obtain whether the sub-item is required. Setting at least one analysis item of applicability, safety, effectiveness, comfort and economy for each sub-item of the treatment scheme, respectively setting corresponding levels/scores for analysis results of each sub-item of the treatment scheme in different analysis items, and calculating comprehensive levels/scores of treatment rationality and necessity of different sub-items according to the levels/scores corresponding to the sub-items in each analysis item and a medical expense management model when performing comprehensive analysis of treatment rationality and necessity of the sub-items of the treatment scheme, so as to provide comprehensive analysis results or sequencing for different sub-items, including comparison among different sub-items.

And calculating comprehensive levels/scores of treatment rationality and necessity for each sub-item in the treatment scheme through comprehensive analysis, and providing an analysis result of treatment scheme cost control according to a preset threshold. The threshold value for adjusting the treatment sub-items or optimizing the treatment intensity can be preset, and when the threshold value of a certain sub-item is smaller than the adjustment threshold value, the treatment sub-item needs to be removed or replaced; if the threshold value of a sub-item is less than the optimal threshold value, the intensity of treatment for that sub-item needs to be reduced.

For example: for a patient with a certain treatment scheme, monitoring blood pressure after an operation to reduce the risk of the patient is reasonable in terms of safety, but the cost for monitoring the dynamic blood pressure is high, so that the problem of over-treatment exists, and the treatment rationality and the necessity of monitoring the dynamic blood pressure are low by calculating the comprehensive level/score of the treatment rationality and the necessity of the sub-item of monitoring the dynamic blood pressure, so that the sub-item needs to be replaced. The intensity of monitoring blood pressure can be reduced, the mode of interval monitoring blood pressure is adopted, the requirement that the blood pressure is monitored after the operation of a patient is met, the problem of high cost does not exist at low cost, and the cost management and control scheme of the patient case comprises the step of monitoring the blood pressure instead of dynamic blood pressure monitoring at intervals.

For another example: for a treatment regimen for a cold patient, it is necessary to treat the virus causing the cold, but it is not necessary to treat the cough with a medication because the patient's cough symptoms are not severe and naturally improve with the cure of the cold virus. By calculating a combined grade/score for the treatment rationality and necessity of the sub-item of medication cough, which is extremely low, it is concluded that medication cough is not necessary, so it is necessary to eliminate medication cough in the treatment regimen.

The medical expense management method of the invention can analyze the treatment rationality and the necessity of the treatment scheme sub-items according to the preset threshold value of the comprehensive grade/score of the sub-items needing to be replaced/removed. If the comprehensive level/score of the sub-item of the treatment scheme meets a preset removal threshold, the sub-item is unnecessary and needs to be removed; if the comprehensive grade/score of the sub-item of the treatment plan meets the preset replacement threshold, the sub-item is low in necessity and needs to be replaced. The threshold value can be obtained through manual setting or big data analysis, and can also be continuously optimized in the using process.

The medical expense management method can also comprise the step of obtaining medical expense management models under different DRG/DIP groups according to manual setting or big data analysis, and the medical expense management models are used for analyzing the treatment rationality and the necessity of each sub-item of a treatment scheme and providing a basis for expense management and control. The healthcare cost management model may include cost management items, metrics, weights, etc. under different DRG/DIP groupings. For example: for the elderly, the weight of comfort is enhanced; for people with good economic conditions, the weight of economy may be reduced. The medical expense management model can also be obtained through manual setting or big data analysis, and can also be continuously optimized in the using process.

The analysis result of the treatment scheme cost management and control can be used for cost management and control auditing of the treatment scheme, cost management and control commenting of the treatment scheme, adjustment suggestion of the treatment scheme cost management and control, and recommendation of a treatment scheme suitable for the cost management and control.

The medical expense management method can also perform rationality analysis on the mutually conflicting parts in a plurality of expense control targets subdivided by different dimensions, provide analysis results according to the relevant rules of medical expense management in the medical expense management database and the specific conditions of patients, and can be used for auditing, commenting, suggesting, recommending and the like of expense management and optimize a medical expense management model according to the relevant analysis results.

The medical expense management method of the invention can also comprise a patient personal information database, wherein the patient personal information database comprises the relevant information of the patient and is used for providing or supplementing the relevant information of the patient. The patient personal information database includes the relevant information of the patient, and the content thereof can include: patient basic information, genetic related information, family health related information such as family medical history, allergy history, regional epidemic history, medication history, surgical history, medical device use history, learning conditions, work conditions, exercise conditions, family conditions, living environment, hobbies, compliance conditions, tolerance conditions, medical insurance conditions, and physiological/psychological/learning/work/physical/sleep/exercise/emotional/metabolic/visual/hearing/mental/attention/diet/immune/growth development/memory/fertility conditions, and time of rest.

The medical expense management method of the invention can also comprise an expense management multi-dimensional element attribute dictionary which is used for processing the matching/comparison of the acquired information from different sources, different data structures, different descriptions and different data standards with the related information and rules in the database. The expense management multi-dimensional element attribute dictionary comprises at least one of a standard dictionary, a synonym corresponding dictionary and a fuzzy matching dictionary of each element attribute related to expense management, and comprises data such as synonyms, structures, combinations and mutual corresponding relations of each dimension element attribute related to each item. The matching/comparing may be performed by using the obtained original information to compare with a dictionary corresponding to each item synonym carried by the cost management multidimensional element attribute dictionary, or may be performed by converting the obtained original information to correspond to each standard dictionary and then comparing with a database, or may be performed by performing fuzzy matching and comparing the obtained original information with each dictionary, or may be a combination of the above methods. The expense management multi-dimensional element attribute dictionary can be established independently or can be included in a medical expense management database.

In the invention, besides adopting the cost management multi-dimensional element attribute dictionary for matching, the matching/comparison between the acquired information and the related information and rules in the database can be processed by methods such as a voice recognition technology, a semantic recognition technology, translation of different languages, an OCR recognition technology, a virtual reality technology, an augmented reality technology, a gesture recognition technology and the like.

The medical expense management method can also comprise a medical insurance settlement function, wherein the medical insurance settlement function comprises uploading data to a medical insurance settlement system and acquiring a medical insurance settlement result. The related data can be processed according to the medical insurance settlement rules to be in accordance with the medical insurance settlement rules, and then the data is uploaded to the medical insurance settlement system to obtain the medical insurance settlement results. The medical expense management method can improve the accuracy and real-time of medical insurance settlement and improve the efficiency of medical administration management through the medical insurance settlement function.

In the invention, the analysis, evaluation, report and other output information of the medical expense management method can be manually completed by professional staff according to the database and various data, or manually completed under the support of the system, or automatically completed by artificial intelligence, or completed by combining a system/artificial intelligence completion part with a manual completion part. The form of the application/output of the related expense management analysis result can be realized by functions of reminding, informing, reporting, system authority limit, system flow limit, control of related systems/equipment/files/authorities and the like; or providing related interfaces to be realized by being in butt joint with other management systems; or an application that provides the analysis results and the associated results are manually implemented by the user.

In the invention, the identity recognition, confirmation, login and electronic signature of the patient, medical personnel and related roles of the medical expense management method, and the storage, transmission and application of personal information, medical information and various analysis results can be encrypted by various methods, so that the related identity/authority can be prevented from being stolen or information is prevented from being leaked. Wherein the encryption algorithm comprises a symmetric encryption algorithm and/or an asymmetric encryption algorithm, such as: the large integer decomposition problem encryption algorithm, the discrete logarithm problem encryption algorithm, the elliptic curve encryption algorithm, specifically, the block chain technique, etc., the encryption hardware may adopt a secret key, a dongle, an encrypted hard disk, etc., and may be encrypted in combination with user equipment hardware, a network address, etc., or may be encrypted in combination with each other.

In the present invention, the data transmission mode of the medical expense management method may be a data line mode, a wired network, a wireless transmission mode, a radio frequency identification mode, a magnetic card read/write mode, a mobile hard disk mode, an NFC mode, a barcode mode, a two-dimensional code mode, and the like. The wireless transmission mode comprises: infrared, bluetooth, wifi, microwave, visible light wave, telecommunication wireless network, ultrasonic/sound wave, radio, etc.

In the invention, the medical expense management method can be used by a single machine, or can be used by users through access type external hardware such as a mobile hard disk, a box, a card and the like, or can be installed on a local server to support the use of the local users, or can be installed on a private cloud server to support the use of the private cloud users, or can be installed on the Internet to provide services for Internet users.

Fig. 2 is a system block diagram of a medical expense management system according to the present invention. As shown in the drawing, the medical expense management system of the present invention includes:

the database module 101 is used for storing a medical expense management database, and the medical expense management database comprises related rules of medical expense management;

an information acquisition module 102, configured to acquire patient information, disease information, and medical information;

the intelligent analysis module 103 is used for dividing the patient into DRG/DIP groups, subdividing each group into one or more subgroups according to different population information and disease information of the patient and a treatment scheme, dividing the patient into suitable subgroups and obtaining a cost management target, decomposing the treatment scheme, comprehensively analyzing the treatment rationality and the necessity of each sub-item, and providing an analysis result of treatment scheme cost control.

The medical expense management system and the medical expense management method of the invention have one-to-one correspondence in technical characteristics, and reference may be made to the description of the medical expense management method, which is not repeated herein.

In summary, the medical expense management method and system of the present invention includes: establishing a medical expense management database; acquiring patient information, disease information and medical information; patients were subjected to DRG/DIP grouping; subdividing each group into one or more subgroups, classifying patients into appropriate subgroups and obtaining cost management objectives; and decomposing the treatment scheme, comprehensively analyzing the treatment rationality and the necessity of each sub-item, and providing an analysis result of the cost control of the treatment scheme. The medical expense management system comprises: the system comprises a database module, an information acquisition module and an intelligent analysis module. According to the medical expense management method and system, the medical expense management is carried out based on the DRG/DIP, the rationality and the necessity of each item of the treatment scheme are comprehensively analyzed from the aspects of applicability, safety, effectiveness, economy, comfort and the like, the treatment intensity of each item or each item of the treatment scheme is adjusted, the medical expense can be accurately controlled, the medical resources are reasonably distributed, the diagnosis and treatment behaviors are standardized, the excessive treatment is avoided, and the economic burden of a patient is reduced.

The above-mentioned embodiments are intended to illustrate the objects, technical solutions and advantages of the present invention in further detail, and it should be understood that the above-mentioned embodiments are merely exemplary embodiments of the present invention, and are not intended to limit the scope of the present invention, and any modifications, equivalent substitutions, improvements and the like made within the spirit and principle of the present invention should be included in the scope of the present invention.

Claims

1. A method for medical expense management, the method comprising:

acquiring patient information, disease information and medical information;

patients were subjected to DRG/DIP grouping;

2. The medical expense management method according to claim 1, wherein: sub-items of the treatment regimen include: at least one of pharmacotherapy/medical device therapy/examination/surgery/chemotherapy/radiotherapy/phototherapy/thermotherapy/magnetotherapy/electrotherapy/magnetotherapy/phonotherapy/immunotherapy/gene therapy/manipulation/physiotherapy/dietotherapy/rehabilitation/exercise/health care/psychological intervention/nutritional support/chinese medical therapy.

3. The medical expense management method according to claim 1, wherein: sub-items of the treatment regimen include: at least one of a diagnostic phase treatment/a pre-operative preparation phase treatment/a perioperative phase treatment/a post-operative observation phase treatment/a convalescent phase treatment.

4. The medical expense management method according to claim 1, wherein: the method further comprises obtaining a medical expense management model under different DRG/DIP groups or subgroups according to manual setting, big data analysis or evidence-based optimization, wherein the medical expense management model comprises expense target decomposition, expense proportion and category detail templates and treatment scheme templates.

5. The medical expense management method of claim 1 further comprising: setting at least one analysis item of applicability, safety, effectiveness, comfort and economy for each sub-item of the treatment scheme, respectively setting corresponding levels/scores for analysis results of each sub-item of the treatment scheme in different analysis items, and calculating comprehensive levels/scores of treatment rationality and necessity of different sub-items according to the levels/scores corresponding to the sub-items in each analysis item and a medical expense management model when performing comprehensive analysis of treatment rationality and necessity of the treatment scheme sub-items.

6. The method of claim 1, wherein the analysis result of the management of the treatment plan cost can be used for auditing the management of the treatment plan cost, commenting the management of the treatment plan cost, giving adjustment advice of the management of the treatment plan cost, and recommending a treatment plan suitable for the management of the cost.

7. The medical expense management method of claim 1 wherein the rules associated with the medical expense management comprise: at least one of rules related to medical insurance/welfare, rules related to economic regulation, rules related to applicability, rules related to contraindications, rules related to caution/attention, rules related to interaction, rules related to allergies, rules related to time, rules related to method of development/method of use, rules related to usage, rules related to adverse reactions, rules related to preparation/protective measures, rules related to suitability/comfort/compliance, and rules related to administrative management.

8. The medical expense management method according to claim 1, wherein: the method further comprises a patient personal information database, wherein the patient personal information database comprises the relevant information of the patient and is used for providing or supplementing the relevant information of the patient.

9. The medical expense management method according to claim 1, wherein: the method further comprises a medical insurance settlement function, wherein the medical insurance settlement function comprises uploading data to a medical insurance settlement system and acquiring a medical insurance settlement result.

10. A medical expense management system, the system comprising: