CN109978702A - Serious disease Commercial supplementary medical insurance loss ratio analysis method and system - Google Patents
Serious disease Commercial supplementary medical insurance loss ratio analysis method and system Download PDFInfo
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- CN109978702A CN109978702A CN201910312656.XA CN201910312656A CN109978702A CN 109978702 A CN109978702 A CN 109978702A CN 201910312656 A CN201910312656 A CN 201910312656A CN 109978702 A CN109978702 A CN 109978702A
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Abstract
The present invention includes: the label for configuring each insurant in serious disease Commercial supplementary medical insurance；The base amount of serious disease business insurance can be entered as the first foundation amount of money by sifting out from the basic medical insurance data of each insurant；The first foundation amount of money based on each insurant and whether belongs to specific crowd subsidy object and obtain the second base amount；The second base amount based on each insurant and whether belongs to serious disease superposition reimbursement object and obtain third base amount；Third base amount based on each insurant, which reduces to have corresponded to, pays amount of money acquisition Claims Resolution benchmark volume；Amount for which loss settled is obtained multiplied by corresponding reimbursement ratio based on the Claims Resolution benchmark volume of each insurant；Amount for which loss settled and corresponding single based on each insurant at least compensate the final supplement medical insurance of amount of money acquisition and compensate the amount of money；All insurants finally supplement the regional supplement medical insurance compensation total value of the cumulative acquisition of the medical insurance compensation amount of money, and area supplements medical insurance compensation total value and obtains finally supplement medical insurance loss ratio divided by current premium.
Description
Technical field
The present invention relates to serious disease Commercial supplementary medical insurances to compensate technical field, supplements more particularly to a kind of serious disease business
Medical insurance loss ratio analysis method and system.
Background technique
With the establishment of medical insurance office and the lasting progress of medical reform, new basic medical insurance policies are frequently put into effect, and new policy is to doctor
The influence for the treatment of expense is huge, however the influence to new policy is difficult to quantify.
Summary of the invention
The present invention is in view of the problems of the existing technology and insufficient, provides a kind of serious disease Commercial supplementary medical insurance loss ratio
Analysis method and system.
The present invention is to solve above-mentioned technical problem by following technical proposals:
The present invention provides a kind of serious disease Commercial supplementary medical insurance loss ratio analysis method, it is characterized in that comprising with
Lower step:
S1, configuration serious disease Commercial supplementary medical insurance in each insurant label, label include insurant whether
Belong to specific crowd subsidy object and the specific crowd subsidy amount of money, whether belong to specific serious disease superposition reimbursement object and specific serious disease
Superposition insured amount, pair amount of money, insurance ratio and a single at least compensate the amount of money；
S2, the basis gold that can enter serious disease business insurance is filtered out from the basic medical insurance data of individual of each insurant
The first foundation amount of money of the volume as each insurant；
S3, the first foundation amount of money based on each insurant and whether belongs to specific crowd subsidy object and obtain each quilt
The second base amount of the insurer；
S4, the second base amount based on each insurant and whether belong to specific serious disease superposition reimbursement object obtain it is every
The third base amount of a insurant；
S5, the third base amount based on each insurant reduce the corresponding pair of amount of money and obtain each insurant's
Claims Resolution benchmark volume；
S6, the Claims Resolution benchmark volume based on each insurant obtain the Claims Resolution of each insurant multiplied by corresponding reimbursement ratio
The amount of money；
S7, the amount for which loss settled based on each insurant and corresponding single compensate the amount of money at least to obtain and each be insured
The amount of money is compensated in the final supplement medical insurance of people；
It is cumulative total to obtain corresponding area supplement medical insurance compensation that the amount of money is compensated in the final supplement medical insurance of S8, all insurants
Volume, area supplement medical insurance compensate total value and obtain final supplement medical insurance loss ratio divided by current corresponding premium.
Preferably, in step s3, when the insurant belongs to specific crowd subsidy object, the second of the insurant
The first foundation amount of money that base amount is equal to the insurant reduces the specific crowd subsidy amount of money；Spy is not belonging in the insurant
When determining crowd's subsidy object, the second base amount of the insurant is equal to the first foundation amount of money of the insurant.
Preferably, in step s 4, when the insurant belongs to specific serious disease superposition reimbursement object, the insurant's
The second base amount that third base amount is equal to the insurant reduces specific serious disease superposition reimbursed sum；In the insurant
When being not belonging to specific serious disease superposition reimbursement object, the third base amount of the insurant is equal to the second basis of the insurant
The amount of money.
Preferably, in the step s 7, when the amount for which loss settled of the insurant is greater than corresponding single and at least compensates the amount of money,
Then the amount for which loss settled that the amount of money is equal to the insurant is compensated in the final supplement medical insurance of the insurant；In the Claims Resolution of the insurant
When the amount of money at least compensates the amount of money less than corresponding single, then the final supplement medical insurance of the insurant is compensated the amount of money and is protected equal to this
The corresponding single of dangerous people at least compensates the amount of money.
The present invention also provides a kind of serious disease Commercial supplementary medical insurance loss ratio analysis systems, it is characterized in that comprising
Configuration module, screening module, the first computing module, the second computing module, third computing module, the 4th computing module, the 5th meter
Calculate module and the 6th computing module；
The configuration module is used to configure the label of each insurant in serious disease Commercial supplementary medical insurance, and label includes
Whether insurant belongs to specific crowd subsidy object and the specific crowd subsidy amount of money, whether belongs to specific serious disease superposition reimbursement pair
As at least compensating the amount of money with specific serious disease superposition insured amount, pair amount of money, insurance ratio and a single；
The screening module is used to from the basic medical insurance data of individual of each insurant filter out that serious disease quotient can be entered
The base amount of industry insurance is as the first foundation amount of money；
First computing module is for the first foundation amount of money based on each insurant and whether belongs to specific crowd
Subsidy calculation and object goes out the second base amount of each insurant；
Second computing module is for the second base amount based on each insurant and whether belongs to specific serious disease
Superposition reimbursement calculation and object goes out the third base amount of each insurant；
The third computing module reduces corresponding for the third base amount based on each insurant and pays the amount of money
Calculate the Claims Resolution benchmark volume of each insurant；
4th computing module is calculated for the Claims Resolution benchmark volume based on each insurant multiplied by corresponding reimbursement ratio
The amount for which loss settled of each insurant out；
5th computing module for based on each insurant amount for which loss settled and corresponding single at least compensate gold
The amount of money is compensated in the final supplement medical insurance that volume calculates each insurant；
6th computing module compensates the amount of money for the final supplement medical insurance based on all insurants and adds up to obtain
Corresponding area supplements medical insurance and compensates total value, and area supplement medical insurance compensates total value divided by current corresponding premium to obtain final supplement
Medical insurance loss ratio.
Preferably, first computing module is used for when the insurant belongs to specific crowd subsidy object, calculating should
The first foundation amount of money that the second base amount of insurant is equal to the insurant reduces the specific crowd subsidy amount of money；In the quilt
When the insurer is not belonging to specific crowd subsidy object, the second base amount for calculating the insurant is equal to the of the insurant
One base amount.
Preferably, second computing module is used for when the insurant belongs to specific serious disease superposition reimbursement object, meter
The third base amount for calculating the insurant reduces specific serious disease superposition reimbursement gold equal to the second base amount of the insurant
Volume；When the insurant is not belonging to specific serious disease superposition reimbursement object, the third base amount for calculating the insurant is equal to
The second base amount of the insurant.
It is at least paid for preferably, the 5th computing module is used to be greater than corresponding single in the amount for which loss settled of the insurant
When paying the amount of money, the amount for which loss settled that the amount of money is equal to the insurant is compensated in the final supplement medical insurance for calculating the insurant；In the quilt
When the amount for which loss settled of the insurer at least compensates the amount of money less than corresponding single, the final supplement medical insurance for calculating the insurant is compensated
The corresponding single that the amount of money is equal to the insurant at least compensates the amount of money.
On the basis of common knowledge of the art, above-mentioned each optimum condition, can any combination to get each preferable reality of the present invention
Example.
The positive effect of the present invention is that:
The present invention is based on basic medical insurance data, the benchmark that can settle a claim into the amount of money of personal serious disease business insurance is calculated,
Claims Resolution a reference value caused by different policies is calculated respectively to change, and serious disease business supplement medical insurance is determined based on corresponding Claims Resolution a reference value
Compensate the amount of money and loss ratio.
The present invention can both quantify the influence that single policy factor changes, and can also quantify the entire effect that more policy factors change,
Carry out quantitative evaluation so as to influence to policy in advance, can effectively help the reasonable evaluation item of Shang Bao company at
This.
Detailed description of the invention
Fig. 1 is the flow chart of the serious disease Commercial supplementary medical insurance loss ratio analysis method of present pre-ferred embodiments.
Fig. 2 is the structural block diagram of the serious disease Commercial supplementary medical insurance loss ratio analysis system of present pre-ferred embodiments.
Specific embodiment
In order to make the object, technical scheme and advantages of the embodiment of the invention clearer, below in conjunction with the embodiment of the present invention
In attached drawing, technical scheme in the embodiment of the invention is clearly and completely described, it is clear that described embodiment is
A part of the embodiment of the present invention, instead of all the embodiments.Based on the embodiments of the present invention, those of ordinary skill in the art
Every other embodiment obtained without making creative work, shall fall within the protection scope of the present invention.
As shown in Figure 1, the present embodiment provides a kind of serious disease Commercial supplementary medical insurance loss ratio analysis methods comprising with
Lower step:
The label of each insurant in step 101, configuration serious disease Commercial supplementary medical insurance, label includes insurant
Whether belong to specific crowd subsidy object and the specific crowd subsidy amount of money, whether belong to specific serious disease superposition reimbursement object and specific
Serious disease superposition insured amount, pair amount of money, insurance ratio and a single at least compensate the amount of money.
Step 102 filters out from the basic medical insurance data of individual of each insurant and can enter serious disease business insurance
The first foundation amount of money of the base amount as each insurant.
The basic medical insurance data of the individual of each insurant include two parts: instant data directly obtain from network
Basic medical insurance data；Manual logging data directly passes through the basic medical insurance data of manual typing.
Step 103, the first foundation amount of money based on each insurant and whether belong to specific crowd subsidy object obtain
The second base amount of each insurant.
Specifically, when the insurant belongs to specific crowd subsidy object, second base amount of the insurant etc.
The specific crowd subsidy amount of money is reduced in the first foundation amount of money of the insurant；Specific crowd subsidy is not belonging in the insurant
When object, the second base amount of the insurant is equal to the first foundation amount of money of the insurant.
Step 104, the second base amount based on each insurant and whether belong to specific serious disease superposition reimbursement object
Obtain the third base amount of each insurant.
Specifically, when the insurant belongs to specific serious disease superposition reimbursement object, the third basis gold of the insurant
The second base amount that volume is equal to the insurant reduces specific serious disease superposition reimbursed sum；It is not belonging in the insurant specific
When serious disease superposition reimbursement object, the third base amount of the insurant is equal to the second base amount of the insurant.
This step quantifies influence of the Single diseases payment to serious disease Commercial supplementary medical insurance loss ratio.
Step 105, the third base amount based on each insurant reduce the corresponding pair of amount of money and obtain each protected
The Claims Resolution benchmark volume of dangerous people.
Step 106 obtains each insurant multiplied by corresponding reimbursement ratio based on the Claims Resolution benchmark volume of each insurant
Amount for which loss settled.
Particularly, turn the outer reimbursement ratio being hospitalized and the second reimbursement ratio is reduced to (such as by the first reimbursement ratio (such as 100%)
80%) influence to serious disease Commercial supplementary medical insurance loss ratio can be realized in this step.
It is each to obtain that step 107, the amount for which loss settled based on each insurant and corresponding single at least compensate the amount of money
The amount of money is compensated in the final supplement medical insurance of insurant.
Specifically, when the amount for which loss settled of the insurant is greater than corresponding single and at least compensates the amount of money, then this is insured
The amount for which loss settled that the amount of money is equal to the insurant is compensated in the final supplement medical insurance of people；The insurant amount for which loss settled be less than pair
When the single answered at least compensates the amount of money, then the correspondence that the amount of money is equal to the insurant is compensated in the final supplement medical insurance of the insurant
Single at least compensate the amount of money.
It is cumulative to obtain corresponding area supplement medical insurance that the amount of money is compensated in the final supplement medical insurance of step 108, all insurants
Total value is compensated, area supplement medical insurance compensates total value and obtains final supplement medical insurance loss ratio divided by current corresponding premium.
Above-mentioned steps quantify influence of the whole medical insurance policies variation to serious disease Commercial supplementary medical insurance loss ratio.
As shown in Fig. 2, the present invention also provides a kind of serious disease Commercial supplementary medical insurance loss ratio analysis systems comprising match
Set module 1, screening module 2, the first computing module 3, the second computing module 4, third computing module 5, the 4th computing module 6,
Five computing modules 7 and the 6th computing module 8.
The configuration module 1 is used to configure the label of each insurant in serious disease Commercial supplementary medical insurance, label packet
Include whether insurant belongs to specific crowd subsidy object and the specific crowd subsidy amount of money, whether belongs to specific serious disease superposition reimbursement
Object and specific serious disease superposition insured amount, pair amount of money, insurance ratio and a single at least compensate the amount of money.
The screening module 2 is used to from the basic medical insurance data of individual of each insurant filter out that serious disease quotient can be entered
The base amount of industry insurance is as the first foundation amount of money.
First computing module 3 is for the first foundation amount of money based on each insurant and whether belongs to specific crowd
Subsidy calculation and object goes out the second base amount of each insurant.Specifically, first computing module 3 is used to be protected at this
For dangerous Genus Homo when specific crowd subsidizes object, the second base amount for calculating the insurant is equal to the first base of the insurant
The plinth amount of money reduces the specific crowd subsidy amount of money；When the insurant is not belonging to specific crowd subsidy object, calculates this and insured
The second base amount of people is equal to the first foundation amount of money of the insurant.
Second computing module 4 is for the second base amount based on each insurant and whether belongs to specific serious disease
Superposition reimbursement calculation and object goes out the third base amount of each insurant.Specifically, second computing module 4 is used at this
When insurant belongs to specific serious disease superposition reimbursement object, the third base amount for calculating the insurant is equal to the insurant
The second base amount reduce specific serious disease superposition reimbursed sum；Specific serious disease superposition reimbursement object is not belonging in the insurant
When, the third base amount for calculating the insurant is equal to the second base amount of the insurant.
The third computing module 5 reduces corresponding for the third base amount based on each insurant and pays the amount of money
Calculate the Claims Resolution benchmark volume of each insurant.
4th computing module 6 is calculated for the Claims Resolution benchmark volume based on each insurant multiplied by corresponding reimbursement ratio
The amount for which loss settled of each insurant out.
5th computing module 7 for based on each insurant amount for which loss settled and corresponding single at least compensate gold
The amount of money is compensated in the final supplement medical insurance that volume calculates each insurant.Specifically, the 5th computing module is used in the quilt
When the amount for which loss settled of the insurer at least compensates the amount of money greater than corresponding single, the final supplement medical insurance for calculating the insurant is compensated
The amount of money is equal to the amount for which loss settled of the insurant；It is less than corresponding single in the amount for which loss settled of the insurant and at least compensates the amount of money
When, the final supplement medical insurance for calculating the insurant compensates the amount of money and at least compensates gold equal to the corresponding single of the insurant
Volume.
6th computing module 8 compensates the amount of money for the final supplement medical insurance based on all insurants and adds up to obtain
Corresponding area supplements medical insurance and compensates total value, and area supplement medical insurance compensates total value divided by current corresponding premium to obtain final supplement
Medical insurance loss ratio.
The present invention can quantify medical insurance change in policy in business insurance underwriting year, and (such as basic medical insurance turns outer be hospitalized and reports
Sell rate variable, implement the Single diseases means of payment etc.) influence changed is compensated to serious disease Commercial supplementary medical insurance.
Although specific embodiments of the present invention have been described above, it will be appreciated by those of skill in the art that these
It is merely illustrative of, protection scope of the present invention is defined by the appended claims.Those skilled in the art is not carrying on the back
Under the premise of from the principle and substance of the present invention, many changes and modifications may be made, but these are changed
Protection scope of the present invention is each fallen with modification.
Claims (8)
1. a kind of serious disease Commercial supplementary medical insurance loss ratio analysis method, which is characterized in that itself the following steps are included:
The label of each insurant, label include whether insurant belongs in S1, configuration serious disease Commercial supplementary medical insurance
Whether specific crowd subsidy object and the specific crowd subsidy amount of money belong to specific serious disease superposition reimbursement object and the superposition of specific serious disease
Insured amount, pair amount of money, insurance ratio and a single at least compensate the amount of money；
S2, the base amount work that can enter serious disease business insurance is filtered out from the basic medical insurance data of individual of each insurant
For the first foundation amount of money of each insurant；
S3, the first foundation amount of money based on each insurant and whether belongs to specific crowd subsidy object and obtain and each insured
The second base amount of people；
S4, the second base amount based on each insurant and whether belongs to specific serious disease superposition reimbursement object and obtain each quilt
The third base amount of the insurer；
S5, the third base amount based on each insurant reduce corresponding and pay the Claims Resolution that the amount of money obtains each insurant
Benchmark volume；
S6, the Claims Resolution benchmark volume based on each insurant obtain the Claims Resolution gold of each insurant multiplied by corresponding reimbursement ratio
Volume；
S7, the amount for which loss settled based on each insurant and corresponding single compensate the amount of money at least to obtain each insurant's
The amount of money is compensated in final supplement medical insurance；
The final supplement medical insurance of S8, all insurants compensate the amount of money and add up to obtain corresponding area supplement medical insurance and compensate total value,
Area supplement medical insurance compensates total value and obtains final supplement medical insurance loss ratio divided by current corresponding premium.
2. serious disease Commercial supplementary medical insurance loss ratio analysis method as described in claim 1, which is characterized in that in step S3
In, when the insurant belongs to specific crowd subsidy object, the second base amount of the insurant is equal to the insurant
The first foundation amount of money reduce specific crowd subsidy the amount of money；When the insurant is not belonging to specific crowd subsidy object, the quilt
The second base amount of the insurer is equal to the first foundation amount of money of the insurant.
3. serious disease Commercial supplementary medical insurance loss ratio analysis method as described in claim 1, which is characterized in that in step S4
In, when the insurant belongs to specific serious disease superposition reimbursement object, the third base amount of the insurant, which is equal to this, to be protected
The second base amount of dangerous people reduces specific serious disease superposition reimbursed sum；Specific serious disease superposition reimbursement is not belonging in the insurant
When object, the third base amount of the insurant is equal to the second base amount of the insurant.
4. serious disease Commercial supplementary medical insurance loss ratio analysis method as described in claim 1, which is characterized in that in step S7
In, when the amount for which loss settled of the insurant is greater than corresponding single and at least compensates the amount of money, then the final supplement of the insurant
The amount for which loss settled that the amount of money is equal to the insurant is compensated in medical insurance；It is minimum to be less than corresponding single in the amount for which loss settled of the insurant
When compensating the amount of money, then the final supplement medical insurance of the insurant is compensated the amount of money and is at least paid for equal to the corresponding single of the insurant
Pay the amount of money.
5. a kind of serious disease Commercial supplementary medical insurance loss ratio analysis system, which is characterized in that it includes configuration module, screening mould
Block, the first computing module, the second computing module, third computing module, the 4th computing module, the 5th computing module and the 6th calculate
Module；
The configuration module is used to configure the label of each insurant in serious disease Commercial supplementary medical insurance, and label includes being protected
Whether dangerous people belong to specific crowd subsidy object and the specific crowd subsidy amount of money, whether belong to specific serious disease superposition reimbursement object and
Specific serious disease superposition insured amount, pair amount of money, insurance ratio and a single at least compensate the amount of money；
The screening module is used to from the basic medical insurance data of individual of each insurant filter out and can protect into serious disease business
The base amount of danger is as the first foundation amount of money；
First computing module is for the first foundation amount of money based on each insurant and whether belongs to specific crowd subsidy
Calculation and object goes out the second base amount of each insurant；
Second computing module is for the second base amount based on each insurant and whether belongs to specific serious disease superposition
Reimbursement calculation and object goes out the third base amount of each insurant；
The third computing module reduces corresponding for the third base amount based on each insurant and pays amount of money calculating
The Claims Resolution benchmark volume of each insurant out；
4th computing module calculates often for the Claims Resolution benchmark volume based on each insurant multiplied by corresponding reimbursement ratio
The amount for which loss settled of a insurant；
5th computing module by the amount for which loss settled of each insurant and corresponding single by least being compensated based on the amount of money
The amount of money is compensated in the final supplement medical insurance for calculating each insurant；
6th computing module compensates the amount of money for the final supplement medical insurance based on all insurants and adds up to be corresponded to
Total value is compensated in area supplement medical insurance, and area supplement medical insurance compensates total value and obtains final supplement medical insurance divided by current corresponding premium
Loss ratio.
6. serious disease Commercial supplementary medical insurance loss ratio analysis system as claimed in claim 5, which is characterized in that described first
Computing module is used to calculate second base amount of the insurant etc. when the insurant belongs to specific crowd subsidy object
The specific crowd subsidy amount of money is reduced in the first foundation amount of money of the insurant；Specific crowd subsidy is not belonging in the insurant
When object, the second base amount for calculating the insurant is equal to the first foundation amount of money of the insurant.
7. serious disease Commercial supplementary medical insurance loss ratio analysis system as claimed in claim 5, which is characterized in that described second
Computing module is used to calculate the third basis gold of the insurant when the insurant belongs to specific serious disease superposition reimbursement object
The second base amount that volume is equal to the insurant reduces specific serious disease superposition reimbursed sum；It is not belonging in the insurant specific
When serious disease superposition reimbursement object, the third base amount for calculating the insurant is equal to the second base amount of the insurant.
8. serious disease Commercial supplementary medical insurance loss ratio analysis system as claimed in claim 5, which is characterized in that the described 5th
Computing module is used to calculate the insurant when the amount for which loss settled of the insurant is greater than corresponding single and at least compensates the amount of money
Final supplement medical insurance compensate the amount of money be equal to the insurant amount for which loss settled；It is less than in the amount for which loss settled of the insurant and corresponds to
Single when at least compensating the amount of money, the correspondence that the amount of money is equal to the insurant is compensated in the final supplement medical insurance for calculating the insurant
Single at least compensate the amount of money.
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| Application Number | Priority Date | Filing Date | Title |
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| CN201910312656.XA CN109978702A (en) | 2019-04-18 | 2019-04-18 | Serious disease Commercial supplementary medical insurance loss ratio analysis method and system |
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| Application Number | Priority Date | Filing Date | Title |
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| CN201910312656.XA CN109978702A (en) | 2019-04-18 | 2019-04-18 | Serious disease Commercial supplementary medical insurance loss ratio analysis method and system |
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