CN114119260A - Medical insurance treatment calculation method and device and electronic equipment - Google Patents
Medical insurance treatment calculation method and device and electronic equipment Download PDFInfo
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Abstract
The application discloses a medical insurance treatment calculation method, a medical insurance treatment calculation device and electronic equipment, wherein the method comprises the following steps: acquiring medical care related information and expense detailed data of medical care personnel; traversing medical expense detailed data, calculating the expenses of self-payment and full self-payment, and using the residual expenses as medical insurance reference data for medical insurance treatment calculation by using the whole body for compliance expenses; and traversing the pre-arranged policy items, comparing the static elements of the medical insurance admission reference data with the static elements in the policy conditions, if the policy items meeting the conditions are found, sequentially running the calculation process of the policy treatment in each policy item according to a specified sequence, and summarizing and outputting the calculation results of the medical insurance treatment after the traversal is finished. The method and the system improve the universality, the simplicity, the operation efficiency and the stability of the system, and simultaneously greatly reduce the workload and the cost during later maintenance and upgrading.
Description
Technical Field
The present application relates to the field of block chain technologies, and in particular, to a medical insurance treatment calculation method and apparatus, and an electronic device.
Background
The traditional medical insurance treatment computing system highly depends on relevant regulations of the areas, and due to different individual settlement policies of different cities, the medical insurance treatment computing systems in different areas have different computing rule requirements, the universality of the medical insurance treatment computing method among the areas is poor, and the processing method has the following defects:
(1) in order to meet the policy requirements of different cities, codes need to be continuously written, logic processing blocks are added, and processing can be performed only by releasing and upgrading program versions, so that chimney-type construction causes great risks to later-stage project operation and maintenance and program stability.
(2) For the history code which is continuously increased for a long time, the later developers may not be fully understood, so in order to avoid the influence of uncertainty, a large number of logic blocks which do not need to be executed are kept in redundant execution, and the system performance and efficiency are seriously reduced along with the advance of time.
(3) Due to the fact that the coupling of historical codes is huge, the speed of development of new requirements is low, the requirements of policy change cannot be kept up with, and the workload of system development is huge.
(4) The traditional method usually needs to access a large amount of databases for value judgment, and when a large amount of services are calculated, the databases are blocked, so that the system is slow and even down.
Disclosure of Invention
In view of one of the above technical problems, the present application provides a medical insurance treatment calculation method to solve the technical problems of poor generality and large workload of upgrade and maintenance of the existing medical insurance treatment calculation method.
The technical scheme adopted by the application is as follows:
a medical insurance treatment calculation method comprises the following steps:
acquiring medical care related information and expense detailed data of medical care personnel;
traversing medical expense detailed data, calculating the expenses of self-payment and full self-payment, and using the residual expenses as medical insurance reference data for medical insurance treatment calculation by using the whole body for compliance expenses;
traversing pre-arranged policy items, comparing static elements of the medical insurance admission reference data with static elements in policy conditions, if the policy items meeting the conditions are found, sequentially operating the calculation process of the policy treatment in each policy item according to a specified sequence, and summarizing and outputting the calculation results of the medical insurance treatment after the traversal is completed, wherein the policy items refer to sectional policy sequence composition items in a local medical insurance policy, the policy conditions refer to element expression combinations for describing medical insurance hospitalization scenes and having logical relations, and the policy items meeting the conditions are found by judging element expression combination logic; the policy treatment refers to the payment mode composition of a policy item, and the static element refers to the minimum unit of an object which has no value change and is relevant to the treatment calculation in the whole medical insurance treatment calculation process.
Further, before acquiring medical care related information and expense detail data of medical care personnel, the method further comprises the following steps:
analyzing and abstracting local medical insurance policy information, extracting all policy items, policy conditions and policy treatment corresponding to the hospitalizing scene from the medical insurance policy information, and arranging and storing the policy conditions and the policy treatment in a parameter library.
Further, the payment mode composition comprises fund composition of the policy item, payment proportion of each fund, payment limit and time stamp.
Furthermore, analyzing and abstracting local medical insurance policy information, extracting all policy items, policy conditions and policy treatments corresponding to the hospitalizing scenes from the medical insurance policy information, arranging and storing the policy items and the policy treatments in a parameter library, traversing medical expense detailed data, calculating the expenses of self-payment and self-payment firstly, and taking the rest expenses as medical insurance access parameter data before the medical insurance treatment calculation is carried out by using the whole body for compliance fee, further comprising the following steps:
and (4) issuing a treatment policy, namely combining the data arranged and stored in the parameter library into data which can be identified by an algorithm model according to rules of medical treatment calculation, and storing the data in a memory database as an algorithm library for medical treatment calculation.
Further, the parameter library adopts Mysql, SQL SERVER, DB and ORECLE; the memory database comprises Memcached, redis and Mongo DB.
Further, traversing the pre-arranged policy items, comparing the static elements of the medical insurance admission reference data with the static elements of the policy conditions, if the policy items meeting the conditions are found, sequentially running the calculation process of the policy treatment in each policy item according to a specified sequence, and summarizing and outputting the calculation results of the medical insurance treatment after the traversal is completed, which specifically comprises the following steps:
traversing expense details of medical insurance entry data;
traversing the policy items in the algorithm library;
comparing the static elements of the medical insurance admission data with the static elements of the policy conditions in all policy items, and judging whether the policy conditions are met;
if the policy items meeting the conditions are found, sequentially running the calculation process of the policy treatment in each policy item according to a specified sequence, and if not, continuously traversing the algorithm library;
judging whether all the policy items in the algorithm library are completely traversed;
if all the policy items in the algorithm library are completely traversed, summarizing the calculation results to obtain a final calculation result and outputting the final calculation result, otherwise, continuously traversing the algorithm library.
Another aspect of the present application further provides a medical insurance treatment computing apparatus, including:
the medical expense detail acquisition module is used for acquiring medical hospitalizing related information and expense detail data of medical insurance personnel;
the medical insurance entrance parameter data calculation module is used for traversing medical expense detailed data, calculating the expenses of self-payment and full self-payment firstly, and using the residual expenses as medical insurance entrance parameter data for performing medical insurance treatment calculation by using the whole body of the compliance expenses;
the medical insurance treatment calculation module is used for traversing pre-arranged policy items, comparing static elements of medical insurance admission parameter data with static elements in policy conditions, if the policy items meeting the conditions are found, sequentially operating the calculation process of the policy treatment in each policy item according to a specified sequence, and summarizing and outputting the calculation results of the medical insurance treatment after the traversal is completed, wherein the policy items refer to sectional policy sequence composition items in a local medical insurance policy, the policy conditions refer to element expression combinations for describing medical insurance hospitalization scenes and having logical relations, and the policy items meeting the conditions are found by judging element expression combination logic; the policy treatment refers to the payment mode composition of a policy item, and the static element refers to the minimum unit of an object which has no value change and is relevant to the treatment calculation in the whole medical insurance treatment calculation process.
Further, still include:
and the policy arranging module is used for analyzing and abstracting local medical insurance policy information, extracting all policy items, policy conditions and policy treatment corresponding to the hospitalizing scene from the medical insurance policy information, and arranging and storing the policy conditions and the policy treatment in a parameter library.
Further, still include:
and the treatment policy issuing module is used for issuing a treatment policy, combining the data arranged and stored in the parameter base into data which can be identified by an algorithm model according to the rules of medical insurance treatment calculation, and storing the data into the memory database as an algorithm base for medical insurance treatment calculation.
The application also provides an electronic device, which comprises a memory, a processor and a computer program stored on the memory and capable of running on the processor, wherein the processor executes the program to realize the medical insurance processing calculation method.
The application also provides a storage medium, the storage medium comprises a stored program, and when the program runs, the device where the storage medium is located is controlled to execute the medical insurance processing calculation method.
Compared with the prior art, the method has the following beneficial effects:
the application provides a medical insurance treatment calculation method, a device, an electronic device and a storage medium, wherein the medical insurance treatment calculation method comprises the following steps: acquiring medical care related information and expense detailed data of medical care personnel; traversing medical expense detailed data, calculating the expenses of self-payment and full self-payment, and using the residual expenses as medical insurance reference data for medical insurance treatment calculation by using the whole body for compliance expenses; and traversing the pre-arranged policy items, comparing the static elements of the medical insurance admission reference data with the static elements in the policy conditions, if the policy items meeting the conditions are found, sequentially running the calculation process of the policy treatment in each policy item according to a specified sequence, and summarizing and outputting the calculation results of the medical insurance treatment after the traversal is finished. When the medical insurance treatment calculation is carried out, static elements of medical insurance admission reference data are compared with static elements of policy conditions in all policy items through the pre-arranged policy items, the policy items meeting the conditions are found, and the calculation process of the policy treatment in the matched policy items is sequentially operated according to the specified sequence, so that the medical insurance treatment calculation can be obtained, when the medical insurance treatment calculation is applied to medical insurance treatment calculation of different city areas, the corresponding policy items are only required to be rearranged in advance according to the local medical insurance policy information according to the corresponding rules, and any adjustment on other partial modules and codes of the system is not required, so that the medical insurance treatment calculation system can be used for multiple purposes, and has the following advantages: the policy configuration data logic is clear; the adaptability to complex policies of different markets is strong; the full-interface visual configuration is realized, and the operation and maintenance are convenient; the development is fast when the policy requirements change; the performance is excellent. The universality, the simplicity, the operation efficiency and the stability of the system are improved, and meanwhile, the workload and the cost during later maintenance and upgrading are greatly reduced.
In addition to the objects, features and advantages described above, other objects, features and advantages will be apparent from the present application. The present application will now be described in further detail with reference to the accompanying drawings.
Drawings
The accompanying drawings, which are incorporated in and constitute a part of this application, illustrate embodiments of the application and, together with the description, serve to explain the application and are not intended to limit the application. In the drawings:
fig. 1 is a flowchart illustrating a medical insurance treatment calculation method according to a preferred embodiment of the present application.
Fig. 2 is a flowchart illustrating a medical insurance treatment calculation method according to another preferred embodiment of the present application.
Fig. 3 is a schematic diagram of the policy arrangement principle of the preferred embodiment of the present application.
Fig. 4 is a schematic view of a static element maintenance visualization interface according to a preferred embodiment of the present application.
Fig. 5 is a schematic diagram of a visual interface for editing static elements according to the preferred embodiment of the present application.
Fig. 6 is a schematic view of a dynamic element maintenance visualization interface according to a preferred embodiment of the present application.
Fig. 7 is a schematic diagram of an edit dynamic element visualization interface in an edit composition mode according to the preferred embodiment of the present application.
Fig. 8 is a schematic diagram of an interface for visualizing editing dynamic elements in QL expression mode according to the preferred embodiment of the present application.
FIG. 9 is a diagram of a policy item maintenance visualization interface in accordance with a preferred embodiment of the present application.
FIG. 10 is a schematic diagram of a policy condition maintenance visualization interface in accordance with a preferred embodiment of the present application.
Fig. 11 is a schematic diagram of an editing policy condition visualization interface according to a preferred embodiment of the present application.
Fig. 12 is a diagram of a pending settlement policy maintenance visualization interface in accordance with a preferred embodiment of the present application.
Fig. 13 is a diagram of an edit pending settlement policy visualization interface in accordance with a preferred embodiment of the present application.
Fig. 14 is a flowchart illustrating a medical insurance treatment calculation method according to another preferred embodiment of the present application.
Fig. 15 is a schematic diagram of a policy handling issuance visualization interface according to a preferred embodiment of the present application.
Fig. 16 is a detailed sub-step diagram of step S5 according to the preferred embodiment of the present application.
Fig. 17 is a general flowchart of a medical insurance treatment calculation method according to a preferred embodiment of the present application.
FIG. 18 is a block diagram of a medical insurance treatment computing device in accordance with a preferred embodiment of the present application.
FIG. 19 is a block diagram of a medical insurance treatment computing device according to another preferred embodiment of the present application.
FIG. 20 is a block diagram of a medical insurance treatment computing device according to another preferred embodiment of the present application.
Fig. 21 is a schematic block diagram of an electronic device entity of the preferred embodiment of the present application.
Fig. 22 is an internal structural view of a computer device of the preferred embodiment of the present application.
Detailed Description
It should be noted that the embodiments and features of the embodiments in the present application may be combined with each other without conflict. The present application will be described in detail below with reference to the embodiments with reference to the attached drawings.
For the convenience of understanding, technical terms involved in the medical insurance treatment calculation method are explained first.
The elements are as follows: refers to the smallest unit of an object associated with a treatment calculation during the calculation of a treatment for medical insurance.
Static elements: the method refers to the fact that the parameters are used as the reference elements in the process of calculation, and the values cannot be changed in the whole calculation process.
Dynamic elements: the system refers to calculation elements in the calculation process, values of the elements in each step in the calculation process can be changed, and the system can be used for realizing memory monitoring on the values.
And (4) policy items: the order composition items in the medical insurance policy include the initial payment standard, the overall stage, the stage of major illness and the like.
And (3) policy conditions: the policy item is an element combination which describes medical insurance hospitalizing scenes and has a logical relationship, and the policy item which meets the condition can be found by judging the combination logic of the elements.
Policy handling: the payment mode composition of the policy item comprises fund composition of the policy item, payment proportion, payment limit, time stamp and the like of each fund.
A parameter library: and the database stores the static elements, the dynamic elements, the policy items, the policy conditions and the policy treatment data.
An algorithm library: and combining the data of the parameter base into data which can be identified by the algorithm model, and storing the data into a memory database.
An algorithm model: the method is a whole set of complete maintainable and developable program for complex calculation of medical insurance treatment by arranging parameters, elements and the like and adopting an algorithm scheduling mode.
As shown in fig. 1, a preferred embodiment of the present application provides a medical insurance treatment calculation method, including the steps of:
s3, acquiring medical care related information and expense detailed data of medical insurance personnel;
s4, traversing the detailed medical expense data, calculating the expenses of self-payment and self-payment firstly, and taking the rest expenses as medical insurance admission reference data for medical insurance treatment calculation of the whole body for compliance expenses;
s5, traversing pre-arranged policy items, comparing static elements of the medical insurance admission reference data with static elements of policy conditions, if the policy items meeting the conditions are found, sequentially operating the calculation process of the policy treatment in each policy item according to a specified sequence, summarizing and outputting the calculation results of the medical insurance treatment after the traversal is completed, wherein the policy items refer to sectional policy sequence composition items in a local medical insurance policy, the policy conditions refer to element expression combinations for describing medical insurance hospitalization scenes and having logical relations, and the policy items meeting the conditions are found by judging element expression combination logic; the policy treatment refers to the payment mode composition of the policy item, the static element refers to the minimum unit of an object which does not change in value in the whole medical insurance treatment calculation process and is related to the treatment calculation, and the payment mode composition comprises the fund composition of the policy item, the payment proportion of each fund, the payment limit and the time stamp.
The embodiment provides a medical insurance treatment calculation method, which comprises the following steps: acquiring medical care related information and expense detailed data of medical care personnel; traversing medical expense detailed data, calculating the expenses of self-payment and full self-payment, and using the residual expenses as medical insurance reference data for medical insurance treatment calculation by using the whole body for compliance expenses; and traversing the pre-arranged policy items, comparing the static elements of the medical insurance admission reference data with the static elements in the policy conditions, if the policy items meeting the conditions are found, sequentially running the calculation process of the policy treatment in each policy item according to a specified sequence, and summarizing and outputting the calculation results of the medical insurance treatment after the traversal is finished. When the medical insurance treatment calculation is carried out, static elements of medical insurance admission reference data are compared with static elements of policy conditions in all policy items through the pre-arranged policy items, the policy items meeting the conditions are found, the calculation process of the policy treatment in the matched policy items is sequentially operated according to the specified sequence, and then the medical insurance treatment calculation can be obtained, when the medical insurance treatment calculation is applied to medical insurance treatment calculation of different regions, the corresponding policy items are only required to be rearranged in advance according to the local medical insurance policy information according to the corresponding rules, and any adjustment on other partial modules and codes of the system is not required, so that the one set of system can be used for multiple times, and the method has the following advantages: the policy configuration data logic is clear; the adaptability to complex policies of different markets is strong; the full-interface visual configuration is realized, and the operation and maintenance are convenient; the development is fast when the policy requirements change; the performance is excellent. The universality, the simplicity, the operation efficiency and the stability of the system are improved, and meanwhile, the workload and the cost during later maintenance and upgrading are greatly reduced.
As shown in fig. 2, in the preferred embodiment of the present application, before acquiring the medical care related information and the expense detail data of the medical insurance personnel, the method further includes the following steps:
s1, analyzing and abstracting local medical insurance policy information, extracting all policy items, policy conditions and policy treatment corresponding to the hospitalizing scene from the medical insurance policy information, and arranging and storing the policy conditions and the policy treatment in a parameter library.
In this embodiment, a policy arrangement process is disclosed, and fig. 3 illustrates an example of a policy for paying a line after a staff member is hospitalized in a tertiary hospital, where local medical insurance policy information is analyzed and abstracted, and all policy items, policy conditions and policy treatments corresponding to the hospitalizing scenes are extracted from the medical insurance policy information, where the policy items are paying lines, the policy conditions are the staff member, the tertiary hospital and the hospitalization, and the policy treatments maintain reimbursement proportions and configurations of bases such as a crewman subsidy base, a major illness subsidy base and personal cash. When the insured person visits the doctor in the foreground, the processes of treatment calculation are carried out in sequence according to the sequence of the policy items, and the results after the calculation of all the policy items meeting the policy conditions are finished are the cost constitution of the insured person seeking the doctor at this time: overall planning, the amount of reimbursed for major disease fund and the amount of self-payment for personal cash. FIG. 3 discloses the algorithmic method principle of the present application: under what conditions, what treatment is enjoyed. All calculation policies can analyze the policy conditions and the composition thereof, so all policy items meeting the policy conditions are calculated, because the treatment calculation is often constrained by different policy information of each city, for example, when the reimbursement cost of one person exceeds 2 ten thousand, according to the local policy, one reimbursement calculation proportion exists for the cost within 1 ten thousand, and another reimbursement calculation proportion exists for the part exceeding 1 ten thousand, so that two different policy items meeting the policy conditions are corresponded, therefore, all policy items meeting the conditions must be subjected to the treatment calculation, and then when the reimbursement cost is calculated, all policy items meeting the conditions must be calculated according to the sequence specified by each local area, that is, the attributes of the policy items include the execution sequence determined by the local medical insurance policy, and the different sequences directly influence the final result, only if the calculation is carried out according to the specified sequence, the calculation result meeting the requirements can be obtained, and the result shows that the cost of the patient for the medical care is formed as follows: the medical insurance reimburses the amount of the cash, and the amount of the cash of the individual needs to be paid by the user. Fig. 3 represents the basic principle of the present embodiment: under what conditions, what treatment is enjoyed. All computational policies can be analyzed for its policy conditions and its composition.
The relevant function module interfaces for policy orchestration in the present application are described below.
1. Static element maintenance module
The module provides a static element maintenance function, and maintains basic data such as medical insurance entry parameter data and the like during the calculation of the medical insurance division, and the codes and code values of the maintained static elements can be visually inquired and selected by a rear configuration module. Meanwhile, the static element lists are also interface parameters which are well communicated and coordinated with an external system, and the aperture is unified (see fig. 4).
FIG. 5 is an edit static element interface in which element attributes and element types are summarized for later filtering selections in configuring policy conditions.
2. Dynamic element maintenance module
This module provides dynamic element maintenance functionality (as shown in FIG. 6), which provides two modes of maintaining dynamic elements: composition and QL expressions are edited. The edit component automatically calculates the return value of the dynamic element by maintaining the relationship of the data in the calculation process (as shown in fig. 7). The QL expression provides a lightweight JAVA-like grammar rule engine, and the expression can be written directly in the interface, achieving the purpose of calculating the return value (as shown in fig. 8).
3. Policy item maintenance module
The module defines the policy item composition contained in the medical insurance zone, and through the visual interface, the policy item composition contained in the medical insurance zone can be conveniently defined, including the medical insurance zone, the policy item name, the policy item code, the policy item description, the latest editing time, the validity and the like, and a user can perform operations such as query, addition, deletion, export and the like on the policy item through the interface, as shown in fig. 9.
4. Policy condition maintenance module
The module is used for maintaining policy conditions, and a business scene during hospitalization is described by maintaining the combination of static elements and logical relation symbols. These policy conditions are chosen by the following policy treatment configuration module, i.e. the algorithm and method principle, under which policy conditions the calculation is based on which policy treatment. The following is a screenshot of a policy condition maintenance interface, which may select a static element, a relation symbol, and a corresponding element value to describe a policy condition, as shown in fig. 10 and 11.
5. Policy handling maintenance module
The module is used for policy treatment maintenance, specific data items are shown in the following diagram, the maintenance function comprises three contents, firstly, a policy item is selected, data such as a capping type, a timestamp, a calculation base number and the like are filled, then, a corresponding policy condition is selected according to a configured policy scene, and finally, a fund type, a reimbursement proportion, a calculation limit and the like are maintained in a settlement policy module, which is specifically shown in fig. 12 and 13.
6. Policy handling issuing module
As shown in fig. 15, the module is used for processing policy issuance, and stores the data stored in the policy arrangement module into an algorithm library after being combined according to the rules of the algorithm model, and provides the data for a computation interface to use when invoking the algorithm model for computation, which is specifically shown in fig. 15.
As shown in fig. 14, in a preferred embodiment of the present application, analyzing and abstracting local medical insurance policy information, extracting all policy items, policy conditions and policy treatments corresponding to the hospitalization scenario from the medical insurance policy information, arranging and storing the policy items and the policy treatments in a parameter library, traversing medical expense detail data, calculating the fees of self-payment and self-payment, and using the remaining fees as medical insurance reference data before calculating the medical insurance treatment for compliance fees in a whole, further includes:
s2, issuing a treatment policy, combining the data arranged and stored in the parameter base into data which can be identified by an algorithm model according to the rules of medical insurance treatment calculation, and storing the data in a memory database as an algorithm base for medical insurance treatment calculation.
Specifically, the parameter library adopts Mysql, SQL SERVER, DB and ORECLE; the memory database comprises Memcached, redis and Mongo DB, in the embodiment, the parameter database adopts Mysql, and the memory database adopts redis.
In this embodiment, before performing formal treatment calculation, a treatment policy is issued, that is, the above arrangement is stored in the data in the parameter library (Mysql database), combining according to the rules of the algorithm model, storing the combination into an algorithm library (a memory database redis), providing the combination for a calculation interface to be used when calling the algorithm model for calculation, thus, frequent data interaction with the Mysql database can be reduced, and the performance can be improved, FIG. 15 is a pending policy issuing interface, a issuing policy button in the interface is clicked, namely, the data in the parameter base (Mysql database) is combined according to the rules of the algorithm model and then stored in the algorithm base (memory database redis) for the calculation interface to use when calling the algorithm model for calculation, all the operations on the data are carried out in the memory, so that frequent interaction with the database is reduced, and the system performance during large data processing is improved.
Specifically, as shown in fig. 16, in a preferred embodiment of the present application, a pre-arranged policy item is traversed, elements of the parameter data are compared with element expressions of policy conditions in all policy items, if a policy item meeting the condition is found, a calculation process of policy treatment in each policy item is sequentially run according to a specified order, and calculation results of medical insurance treatment are summarized and output after the traversal is completed, which specifically includes the steps of:
s51, traversing the expense detail of medical insurance parameter data;
s52, traversing the policy items in the algorithm library;
s53, comparing the static elements of the medical insurance admission reference data with the static elements of the policy conditions in all policy items, and judging whether the policy conditions are met;
s54, if the policy items meeting the conditions are found, sequentially running the calculation process of the policy treatment in each policy item according to a specified sequence, otherwise, continuously traversing the algorithm library;
s55, judging whether all the policy items in the algorithm library are completely traversed;
and S56, if all the policy items in the algorithm library are completely traversed, summarizing the calculation results to obtain a final calculation result and outputting the final calculation result, and otherwise, continuously traversing the algorithm library.
The embodiment discloses the process of calculating the medical insurance treatment by traversing the algorithm library and condition matching through the algorithm model in detail, and it can be seen that, in the method of the embodiment, no matter the medical insurance treatment is used for calculating any local market, the specific flow of the algorithm model is consistent, the only difference is that the data in the traversed algorithm library is different, that is, each local market can correspond to the algorithm libraries with different contents according to the difference of the medical insurance policy information, the data in the algorithm libraries are from the parameter libraries which are arranged and kept well through the visual interfaces in advance, because of the universality of the algorithm model, the embodiment can be conveniently implemented and used in different local areas, and is not influenced by the medical insurance policy information of each local market, that is, the method can decouple and separate the policy and the algorithm model during the medical insurance treatment calculation, when the algorithm model needs to calculate the medical insurance treatment, the medical insurance treatment meeting the requirements of various municipal policies can be calculated only by calling an algorithm library corresponding to medical insurance policy information of various cities, through the decoupling separation, not only can the policy configuration be flexibly arranged, but also the configured policy data can be executed to generate corresponding results depending on the algorithm model, the goal of applying and deploying the system in various cities is realized only by developing one set of system, the universality, the simplicity, the operating efficiency and the stability of the system are improved, and meanwhile, the workload and the cost during later maintenance and upgrading are greatly reduced.
Fig. 17 is a general flow diagram of the present application: medical insurance policy information is arranged through a system interface and then stored in a parameter library (Mysql database), medical insurance policy issuing extracts data from the parameter library and issues the data to an algorithm library (Redis memory database), algorithm scheduling and medical insurance policy calculation circularly traverse the algorithm library to acquire medical insurance policy data for calculation, and finally corresponding calculation results are generated, so that the embodiment of the application has the following characteristics:
(1) the requirements of policy making and quick online of different cities can be met only by adjusting the configuration of policy parameters without upgrading programs or redundant code operation and maintenance.
(2) The historical policy data can be easily found out on the arrangement interface, and is visual and clear.
(3) The algorithm model has no database connection, all calculation-related policy data are in a memory, cache means of redis and ehcache are fully utilized, calculation under the condition of large concurrency is carried out, and the performance bottleneck is eliminated.
As shown in fig. 18, another aspect of the present application further provides a medical insurance treatment computing device, including:
the medical expense detail acquisition module is used for acquiring medical hospitalizing related information and expense detail data of medical insurance personnel;
the medical insurance entrance parameter data calculation module is used for traversing medical expense detailed data, calculating the expenses of self-payment and full self-payment firstly, and using the residual expenses as medical insurance entrance parameter data for performing medical insurance treatment calculation by using the whole body of the compliance expenses;
the medical insurance treatment calculation module is used for traversing pre-arranged policy items, comparing static elements of medical insurance admission parameter data with static elements in policy conditions, if the policy items meeting the conditions are found, sequentially operating the calculation process of the policy treatment in each policy item according to a specified sequence, and summarizing and outputting the calculation results of the medical insurance treatment after the traversal is completed, wherein the policy items refer to sectional policy sequence composition items in a local medical insurance policy, the policy conditions refer to element expression combinations for describing medical insurance hospitalization scenes and having logical relations, and the policy items meeting the conditions are found by judging element expression combination logic; the policy treatment refers to the payment mode composition of a policy item, and the static element refers to the minimum unit of an object which has no value change and is relevant to the treatment calculation in the whole medical insurance treatment calculation process.
Specifically, as shown in fig. 19, the medical insurance treatment computing device further includes:
and the policy arranging module is used for analyzing and abstracting local medical insurance policy information, extracting all policy items, policy conditions and policy treatment corresponding to the hospitalizing scene from the medical insurance policy information, and arranging and storing the policy conditions and the policy treatment in a parameter library.
Specifically, as shown in fig. 20, the medical insurance treatment computing device further includes:
and the treatment policy issuing module is used for issuing a treatment policy, combining the data arranged and stored in the parameter base into data which can be identified by an algorithm model according to the rules of medical insurance treatment calculation, and storing the data into the memory database as an algorithm base for medical insurance treatment calculation.
As shown in fig. 21, a preferred embodiment of the present application further provides an electronic device, which includes a memory, a processor, and a computer program stored in the memory and executable on the processor, and when the processor executes the computer program, the method for calculating medical insurance treatment is implemented.
As shown in fig. 22, the preferred embodiment of the present application also provides a computer device, the internal structure of which can be as shown in fig. 22. The computer device includes a processor, a memory, and a network interface connected by a system bus. Wherein the processor of the computer device is configured to provide computing and control capabilities. The memory of the computer device comprises a nonvolatile storage medium and an internal memory. The non-volatile storage medium stores an operating system and a computer program. The internal memory provides an environment for the operation of an operating system and computer programs in the non-volatile storage medium. The network interface of the computer device is used for communicating with other external computer devices through network connection. The computer program is executed by a processor to realize the medical insurance processing calculation method.
Those skilled in the art will appreciate that the architecture shown in fig. 22 is merely a block diagram of some of the structures associated with the disclosed aspects and is not intended to limit the computing devices to which the disclosed aspects apply, as particular computing devices may include more or less devices than those shown, or may combine certain devices, or have a different arrangement of devices.
The storage medium comprises a stored program, and when the program runs, the device where the storage medium is located is controlled to execute the medical insurance processing calculation method.
It should be noted that the steps illustrated in the flowcharts of the figures may be performed in a computer system such as a set of computer-executable instructions and that, although a logical order is illustrated in the flowcharts, in some cases, the steps illustrated or described may be performed in an order different than presented herein.
The functions of the method of the present embodiment, if implemented in the form of software functional units and sold or used as independent products, may be stored in one or more storage media readable by a computing device. Based on such understanding, part of the contribution to the prior art of the embodiments of the present application or part of the technical solution may be embodied in the form of a software product stored in a storage medium and including several instructions for causing a computing device (which may be a personal computer, a server, a mobile computing device or a network device) to execute all or part of the steps of the method described in the embodiments of the present application. And the aforementioned storage medium includes: a U-disk, a removable hard disk, a Read-Only Memory (ROM), a Random Access Memory (RAM), a magnetic disk or an optical disk, and other various media capable of storing program codes.
The above description is only a preferred embodiment of the present application and is not intended to limit the present application, and various modifications and changes may be made by those skilled in the art. Any modification, equivalent replacement, improvement and the like made within the spirit and principle of the present application shall be included in the protection scope of the present application.
Claims (10)
1. A medical insurance treatment calculation method is characterized by comprising the following steps:
acquiring medical care related information and expense detailed data of medical care personnel;
traversing medical expense detailed data, calculating the expenses of self-payment and full self-payment, and using the residual expenses as medical insurance reference data for medical insurance treatment calculation by using the whole body for compliance expenses;
traversing pre-arranged policy items, comparing static elements of the medical insurance admission reference data with static elements in policy conditions, if the policy items meeting the conditions are found, sequentially operating the calculation process of the policy treatment in each policy item according to a specified sequence, and summarizing and outputting the calculation results of the medical insurance treatment after the traversal is completed, wherein the policy items refer to sectional policy sequence composition items in a local medical insurance policy, the policy conditions refer to element expression combinations for describing medical insurance hospitalization scenes and having logical relations, and the policy items meeting the conditions are found by judging element expression combination logic; the policy treatment refers to the payment mode composition of a policy item, and the static element refers to the minimum unit of an object which has no value change and is relevant to the treatment calculation in the whole medical insurance treatment calculation process.
2. The medical insurance treatment calculation method of claim 1,
before medical care related information and expense detail data of medical care personnel are acquired, the method further comprises the following steps:
analyzing and abstracting local medical insurance policy information, extracting all policy items, policy conditions and policy treatment corresponding to the hospitalizing scene from the medical insurance policy information, and arranging and storing the policy conditions and the policy treatment in a parameter library.
3. The medical insurance treatment calculation method of claim 2, wherein the method includes
The payment mode composition comprises fund composition of the policy item, payment proportion of each fund, payment limit and time stamp.
4. The medical insurance treatment calculation method of claim 2,
analyzing and abstracting local medical insurance policy information, extracting all policy items, policy conditions and policy treatment corresponding to the hospitalizing scene from the medical insurance policy information, arranging and storing the policy conditions and the policy treatment in a parameter library, traversing medical expense detailed data, calculating the expenses of self-payment and self-payment firstly, and taking the residual expenses as medical insurance reference data before calculating the medical insurance treatment with the whole body for compliance expenses, and further comprising the following steps:
and (4) issuing a treatment policy, namely combining the data arranged and stored in the parameter library into data which can be identified by an algorithm model according to rules of medical treatment calculation, and storing the data in a memory database as an algorithm library for medical treatment calculation.
5. The medical insurance treatment calculation method of claim 4,
the parameter library adopts Mysql, SQL SERVER, DB and ORECLE; the memory database comprises Memcached, redis and Mongo DB.
6. The medical insurance treatment calculation method of claim 4,
traversing the pre-arranged policy items, comparing the static elements of the medical insurance admission reference data with the static elements of the policy conditions, if the policy items meeting the conditions are found, sequentially running the calculation process of the policy treatment in each policy item according to a specified sequence, and summarizing and outputting the calculation results of the medical insurance treatment after the traversal is finished, which specifically comprises the following steps:
traversing expense details of medical insurance entry data;
traversing the policy items in the algorithm library;
comparing the static elements of the medical insurance admission data with the static elements of the policy conditions in all policy items, and judging whether the policy conditions are met;
if the policy items meeting the conditions are found, sequentially running the calculation process of the policy treatment in each policy item according to a specified sequence, and if not, continuously traversing the algorithm library;
judging whether all the policy items in the algorithm library are completely traversed;
if all the policy items in the algorithm library are completely traversed, summarizing the calculation results to obtain a final calculation result and outputting the final calculation result, otherwise, continuously traversing the algorithm library.
7. A medical treatment encounter computing device, comprising:
the medical expense detail acquisition module is used for acquiring medical hospitalizing related information and expense detail data of medical insurance personnel;
the medical insurance entrance parameter data calculation module is used for traversing medical expense detailed data, calculating the expenses of self-payment and full self-payment firstly, and using the residual expenses as medical insurance entrance parameter data for performing medical insurance treatment calculation by using the whole body of the compliance expenses;
the medical insurance treatment calculation module is used for traversing pre-arranged policy items, comparing static elements of medical insurance admission parameter data with static elements in policy conditions, if the policy items meeting the conditions are found, sequentially operating the calculation process of the policy treatment in each policy item according to a specified sequence, and summarizing and outputting the calculation results of the medical insurance treatment after the traversal is completed, wherein the policy items refer to sectional policy sequence composition items in a local medical insurance policy, the policy conditions refer to element expression combinations for describing medical insurance hospitalization scenes and having logical relations, and the policy items meeting the conditions are found by judging element expression combination logic; the policy treatment refers to the payment mode composition of a policy item, and the static element refers to the minimum unit of an object which has no value change and is relevant to the treatment calculation in the whole medical insurance treatment calculation process.
8. The medical treatment and insurance treatment computing device of claim 7, further comprising:
and the policy arranging module is used for analyzing and abstracting local medical insurance policy information, extracting all policy items, policy conditions and policy treatment corresponding to the hospitalizing scene from the medical insurance policy information, and arranging and storing the policy conditions and the policy treatment in a parameter library.
9. The medical treatment and insurance treatment computing device of claim 8, further comprising:
and the treatment policy issuing module is used for issuing a treatment policy, combining the data arranged and stored in the parameter base into data which can be identified by an algorithm model according to the rules of medical insurance treatment calculation, and storing the data into the memory database as an algorithm base for medical insurance treatment calculation.
10. An electronic device comprising a memory, a processor, and a computer program stored on the memory and executable on the processor, wherein the processor implements the medical insurance treatment calculation method of any one of claims 1 to 6 when executing the program.
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