CN116563039A - Medical insurance management method and system based on DRG/DIP - Google Patents
Medical insurance management method and system based on DRG/DIP Download PDFInfo
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Abstract
The invention relates to the technical field of electronic information, and particularly discloses a medical insurance management method and system based on DRG/DIP, wherein the method comprises the following steps: and (3) reclassifying and storing the items of each medical insurance information service which is included in the medical insurance range, storing a plurality of medicaments for treating the same condition under the mutually related catalogs according to the same pharmacological action, and correspondingly forming an index table. After a doctor gives an initial scheme for treatment according to a diagnosis report of a patient, the initial scheme is identified in the automatic identification system, a plurality of items for the initial scheme in treatment information are taken, search is carried out in a memory by forming search words by the items for the initial scheme, whether the items for the initial scheme correspond to the memory or not is checked, and then various compound calculations are carried out according to the DRG/DIP pricing system, so that a final recommended medication scheme is obtained for the doctor or the patient to refer to.
Description
Technical Field
The invention relates to the technical field of electronic information, in particular to a medical insurance charging selection technology, and particularly relates to a medical insurance management method and system based on DRG/DIP.
Background
The current medical insurance payment mechanism is divided into a DRG charging mode and a DIP charging mode; DRG refers to the division of hospitalized patients into a number of disease groups according to the similarity of disease severity, treatment complexity and resource consumption, and covers in principle all acute hospitalized patients (subacute and chronic diseases, such as chronic psychotic diseases, tranquilization care, pure traditional Chinese medicine treatment, etc. not suitable for payment on DRG), and factors determining patient inclusion into the group include the primary diagnosis and primary treatment modality and complications, age, number of days of hospitalization, etc. of the hospitalized patient. The DIP is a method for paying to medical institutions by carrying out exhaustion and clustering on the disease diagnosis and treatment modes of each case according to the reality matching relation, combining stable inpatient diseases, determining corresponding disease point according to the proportion relation between various disease cost average values, technical difficulty and the like and a certain reference disease, and calculating the total payment amount by combining point unit price and the total points developed by each medical institution.
However, neither DRG charging nor DIP charging is used for the purpose of reducing patient self-charge, and either DRG charging alone or DIP charging alone is not the best solution in practice. For different diseases and disease treatment schemes, various alternatives can be formed by DRG individual charging, DIP individual charging or DRG fee and DIP composite charging according to factors such as medicines, price of using equipment, alternatives of the same type of medicines or equipment, voluntary selection of patients and the like, and the alternatives can be used for doctors and patients to select and refer to the final treatment scheme.
Disclosure of Invention
Accordingly, the present invention is directed to a medical insurance management method and system based on DRG/DIP.
In order to achieve the above purpose, the invention provides a medical insurance management method based on DRG/DIP, comprising the following steps: a memory providing medical insurance management, the memory being arranged into a plurality of storage areas, each storage area being arranged into a plurality of storage directories, and each directory being configured to have at least one associated directory; configuring basic information for single items under each medical insurance information service according to a set compiling rule, classifying all the items under the same medical insurance information service by using the basic information, classifying the items with the same pharmacology or the same use function into the same classification catalog, storing the corresponding single item in each classification catalog into a storage catalog in a storage area, storing the corresponding single item with the other items with the same pharmacology or the same use function into an association catalog, setting corresponding storage index words for each storage catalog and the association catalog based on the basic information, forming a corresponding index table by using the storage index words, in the index table, using the storage index words corresponding to the items under the storage catalog as main index words, using the storage index words of the other items under the association catalog associated with the storage catalog as auxiliary index words, and associating the main index words and the auxiliary index words in the association table; when a diagnosis report of a user is circulated, after loading the diagnosis report by any doctor client, the doctor client invokes the attribute setting of the diagnosis report, writes loading time in the attribute of the diagnosis report, and a doctor develops an initial treatment scheme according to the diagnosis report, associates the initial scheme with the diagnosis report, takes the loading time written in the attribute of the diagnosis report as the identification code of the initial scheme while associating, and sends the initial scheme to a management end server along with the diagnosis report; after receiving the diagnosis report and the initial scheme related to the diagnosis report, the management end server firstly identifies the identification code of the initial scheme, secondly loads the diagnosis report, analyzes the loading time recorded in the attribute of the diagnosis report, carries out consistency verification on the loading time and the identification code, and inputs the diagnosis report and the initial scheme corresponding to the diagnosis report into an automatic identification system arranged in the management end server after the verification is passed; the automatic identification system loads an initial scheme, identifies treatment information in the initial scheme, acquires a plurality of items for the initial scheme in the treatment information, calls the memory, forms index words for searching in the memory according to a set compiling rule for the plurality of items for the initial scheme, searches each index word for searching in an index table to check whether the index word for searching has a corresponding main index word or auxiliary index word in the index table, and if so, acquires a plurality of items with the same pharmacology or the same using function corresponding to any one of the main index word or the auxiliary index word correspondingly, and the obtained multiple items are used as a combination item to replace the corresponding initial scheme item, if the combination item does not exist, the initial scheme item is reserved, the reserved initial scheme item and the obtained combination item are freely combined according to a set mode to obtain multiple treatment schemes, the multiple treatment schemes are input into a DRG/DIP pricing system to conduct pricing accounting, multiple pricing accounting results are formed, the multiple pricing accounting results are compared, the pricing accounting results are ordered according to the size of the medical insurance reimbursement amount, the ordered multiple pricing accounting results are compiled into corresponding accounting sheets, the accounting sheets are associated with the corresponding initial scheme, and after the association, the doctor client side formulated by the initial scheme is pushed to the management end server.
Further, configuring the base information according to the set compilation rule includes: (1) a first configuration having a name of a single item as basic information; (2) as a second configuration, accounting of individual items in the DRG/DIP accounting system; (3) the pharmacologic or usage functions of the individual items are taken as a third configuration.
Further, the setting mode is as follows: all reserved initial schemes are used as fixed options; any one of the combination items is taken as a selected option, and the fixed option and the selected option are combined.
The invention also provides a medical insurance management system based on the DRG/DIP, which comprises: a management end server and a plurality of doctor clients connected with the management end server; the management end server is provided with a memory, a compiling module, a classifying module, an index table generating module, a circulation module, a unification identifying module, an automatic identifying system and a DRG/DIP pricing system; wherein the DRG/DIP pricing system is arranged in the automatic identification system; the compiling module is used for configuring basic information of single items under the same medical insurance information service according to a set compiling rule; the classifying module is used for classifying all the items under the same medical insurance information service according to the basic information, and classifying the items with the same pharmacology or the same using function into the same classification catalog; the memory has a plurality of memory regions, each memory region is configured as a plurality of memory directories, and each directory is configured with at least one associated directory; storing any single item in each classification catalog under a storage catalog in a storage area, and storing other items with the same pharmacology or using functions as the items in the associated catalog; the index table generation module is used for setting corresponding storage index words for each storage directory and each associated directory based on the basic information, forming a corresponding index table by using the storage index words, in the index table, taking the storage index words corresponding to the items under the storage directory as main index words, taking the storage index words of other items under the associated directory associated with the storage directory as auxiliary index words, and associating the main index words and the auxiliary index words in the associated table; the circulation module is used for calling the attribute setting of the diagnosis report after any doctor client loads the diagnosis report when the diagnosis report of the user is circulated, writing the loading time in the attribute of the diagnosis report, planning a treatment initial scheme by a doctor according to the diagnosis report, associating the initial scheme with the diagnosis report, taking the loading time written in the attribute of the diagnosis report as the identification code of the initial scheme while associating, and sending the initial scheme to the identification module along with the diagnosis report; the consistency recognition module is used for recognizing the recognition code of the initial scheme on one hand and loading the diagnosis report on the other hand after receiving the diagnosis report and the initial scheme related to the diagnosis report, analyzing the loading time recorded in the attribute of the diagnosis report, carrying out consistency verification on the loading time and the recognition code, and inputting the diagnosis report and the initial scheme corresponding to the diagnosis report into an automatic recognition system arranged in the management end server after the verification is passed; the automatic identification system is used for loading an initial scheme, identifying treatment information in the initial scheme, acquiring a plurality of initial scheme items in the treatment information, calling the memory by the automatic identification system, forming index words for searching by using the plurality of initial scheme items according to a set compiling rule in the memory, searching in an index table by using each index word for searching, checking whether the index words for searching have corresponding main index words or auxiliary index words in the index table, if so, acquiring a plurality of items with the same pharmacology or the same use function by using any one of the main index words or the auxiliary index words correspondingly, taking the plurality of obtained items as a combined item to replace the corresponding initial scheme item, if not, reserving the initial scheme item, freely combining the reserved initial scheme item and the obtained combined item according to the set compiling rule, inputting the plurality of treatment schemes into the DRG/DIP system, calculating a plurality of check results, acquiring the corresponding check results by using any one of the main index words or the auxiliary index words, and making the corresponding check results to a corresponding customer account by a doctor after the doctor is calculated, and after the doctor is calculated and ordered to the corresponding check results are calculated, the corresponding to the corresponding check results are calculated and the corresponding to the customer account and the corresponding to the service account and the price.
Further, the storage is provided with a storage guiding unit, and the storage guiding unit is used for storing any one single item under the same category as a storage catalog corresponding to the main index in the storage area, and storing other items with the same pharmacology or the same use function with the item under the same category as auxiliary indexes in the associated catalog.
Further, the compiling module is provided with a first configuration unit, a second configuration unit and a third configuration unit; wherein the first configuration unit is used for a first configuration taking the name of a single item as basic information; the second configuration unit is used for calculating the price of a single item in the DRG/DIP price calculating system as a second configuration; the third configuration unit is used for taking pharmacology or using functions of the single item as a third configuration.
Further, the circulation module includes: the synchronous clock unit is used for providing reference clocks for a plurality of doctor clients connected with the management end server and the management end server; the circulation analysis unit is used for analyzing the data transmission between the management end server and the doctor client to judge whether the transmission contains a diagnosis report or not, so as to form a judgment result; the relay selection unit is used for selecting a corresponding receiving and transmitting channel to transmit data based on the judging result; wherein, the data transmission containing the diagnosis report is transmitted by the first receiving and transmitting channel; data transfer without diagnostic report is transferred with the second transceiving channel.
Further, the doctor client is internally provided with: the time flow marking unit is used for calling the attribute setting of the diagnosis report after any doctor client loads the diagnosis report, and writing loading time in the attribute of the diagnosis report; an initial plan generation unit for forming a treatment initial plan based on a diagnosis report by a doctor and inputting basic medical resource information forming the initial plan through an externally accessed input device; and the association unit is used for associating the initial scheme with the diagnosis report, and taking the loading time written in the attribute of the diagnosis report as the identification code of the initial scheme at the same time of association.
Further, the attribute of the diagnosis report is a file attribute of the diagnosis report; and, at a doctor client, the file attributes of the diagnostic report are configured to be readable and writable; at the administrative server, the file attributes of the diagnostic report are configured to be readable and non-writable.
Further, the identification module has: the identification unit is used for identifying the identification code of the initial scheme; the consistency verification is used for loading the diagnosis report, analyzing the loading time recorded in the attribute of the diagnosis report and carrying out consistency verification on the loading time and the identification code; the consistency verification is used for judging whether the initial scheme is the latest scheme or not by taking the time flow at the time of circulation as a main line.
Based on the existing electronic informatization systems of medicines, instruments and the like, the application reclassifies and stores the items (medicines or medical instruments) of each medical insurance information service in 15 medical insurance information services which can be brought into medical insurance ranges at present, and takes medicines as examples, multiple medicines for treating the same symptoms are stored under the mutually related catalogs according to the same pharmacological action, and an index table is correspondingly formed. After the doctor gives an initial scheme for treatment according to the diagnosis report of the patient, the doctor identifies the initial scheme in the automatic identification system, a plurality of items for the initial scheme in the treatment information are taken, the items for the initial scheme are formed into search words for searching in a memory, whether the items for the initial scheme correspond to the memory or not is checked, if the items for the initial scheme correspond to the memory, the category of medical insurance is included, if the items for the initial scheme do not correspond to the memory, the items for the initial scheme are self-charged items, and then various composite calculation is carried out according to the DRG/DIP pricing system, so that a final recommended medication scheme is obtained for the doctor or the patient to refer to.
Drawings
FIG. 1 is a flow chart of the method of the present invention.
Fig. 2 is a schematic diagram of the framework of the system of the present invention.
Detailed Description
The following description of the embodiments of the present invention will be made clearly and completely with reference to the accompanying drawings, in which it is apparent that the embodiments described are only some embodiments of the present invention, but not all embodiments. All other embodiments, which can be made by those skilled in the art based on the embodiments of the invention without making any inventive effort, are intended to be within the scope of the invention.
The application is based on a medicine and instrument management system used by the current hospital, and based on the management system, the items (medicines or medical instruments) of each medical insurance information service in 15 medical insurance information services which are included in the medical insurance range are reclassified and stored, and the reclassified and stored data are used as a database for calculating and accounting in the medical insurance range of the application.
According to the same scheme, medicines, medical instruments and the like which cannot be included in the medical insurance range are also classified and stored in the same way, and the medicines, the medical instruments and the like which cannot be included in the medical insurance range are used as a database for price accounting in the application.
In the present application, the term "including the medical insurance category" is taken as an example, but does not represent the term "not including the medical insurance category" as a scope of the present application, and it should be noted that among the term "not including the medical insurance category," there is a price difference between medical devices having the same pharmacology or the same usage function, and there is a great difference between individual items, which are all factors of final pricing.
Referring to fig. 1 to 2, the present invention provides a medical insurance management method based on DRG/DIP, comprising the steps of: a memory providing medical insurance management, the memory being arranged into a plurality of storage areas, each storage area being arranged into a plurality of storage directories, and each directory being configured to have at least one associated directory; configuring basic information for single items under each medical insurance information service according to a set compiling rule, classifying all the items under the same medical insurance information service by using the basic information, classifying the items with the same pharmacology or the same use function into the same classification catalog, storing the corresponding single item in each classification catalog into a storage catalog in a storage area, storing the corresponding single item with the other items with the same pharmacology or the same use function into an association catalog, setting corresponding storage index words for each storage catalog and the association catalog based on the basic information, forming a corresponding index table by using the storage index words, in the index table, using the storage index words corresponding to the items under the storage catalog as main index words, using the storage index words of the other items under the association catalog associated with the storage catalog as auxiliary index words, and associating the main index words and the auxiliary index words in the association table; when a diagnosis report of a user is circulated, after loading the diagnosis report by any doctor client, the doctor client invokes the attribute setting of the diagnosis report, writes loading time in the attribute of the diagnosis report, and a doctor develops an initial treatment scheme according to the diagnosis report, associates the initial scheme with the diagnosis report, takes the loading time written in the attribute of the diagnosis report as the identification code of the initial scheme while associating, and sends the initial scheme to a management end server along with the diagnosis report; after receiving the diagnosis report and the initial scheme related to the diagnosis report, the management end server firstly identifies the identification code of the initial scheme, secondly loads the diagnosis report, analyzes the loading time recorded in the attribute of the diagnosis report, carries out consistency verification on the loading time and the identification code, and inputs the diagnosis report and the initial scheme corresponding to the diagnosis report into an automatic identification system arranged in the management end server after the verification is passed; the automatic identification system loads an initial scheme, identifies treatment information in the initial scheme, acquires a plurality of items for the initial scheme in the treatment information, calls the memory, forms index words for searching in the memory according to a set compiling rule for the plurality of items for the initial scheme, searches each index word for searching in an index table to check whether the index word for searching has a corresponding main index word or auxiliary index word in the index table, and if so, acquires a plurality of items with the same pharmacology or the same using function corresponding to any one of the main index word or the auxiliary index word correspondingly, and the obtained multiple items are used as a combination item to replace the corresponding initial scheme item, if the combination item does not exist, the initial scheme item is reserved, the reserved initial scheme item and the obtained combination item are freely combined according to a set mode to obtain multiple treatment schemes, the multiple treatment schemes are input into a DRG/DIP pricing system to conduct pricing accounting, multiple pricing accounting results are formed, the multiple pricing accounting results are compared, the pricing accounting results are ordered according to the size of the medical insurance reimbursement amount, the ordered multiple pricing accounting results are compiled into corresponding accounting sheets, the accounting sheets are associated with the corresponding initial scheme, and after the association, the doctor client side formulated by the initial scheme is pushed to the management end server.
In the above, configuring the basic information according to the set compilation rule includes: (1) a first configuration having a name of a single item as basic information; (2) as a second configuration, accounting of individual items in the DRG/DIP accounting system; (3) the pharmacologic or usage functions of the individual items are taken as a third configuration.
The first configuration, the second configuration and the third configuration are not necessarily included, wherein the first configuration is used as a compiling basis of the search term, the second configuration is used as a price accounting basis, and the third configuration is used as a classification basis.
In the above, the setting mode is as follows: all reserved initial schemes are used as fixed options; any one of the combination items is taken as a selected option, and the fixed option and the selected option are combined.
The invention also provides a medical insurance management system based on the DRG/DIP, which comprises: a management end server and a plurality of doctor clients connected with the management end server; the management end server is provided with a memory, a compiling module, a classifying module, an index table generating module, a circulation module, a unification identifying module, an automatic identifying system and a DRG/DIP pricing system; wherein the DRG/DIP pricing system is arranged in the automatic identification system; the compiling module is used for configuring basic information of single items under the same medical insurance information service according to a set compiling rule; the classifying module is used for classifying all the items under the same medical insurance information service according to the basic information, and classifying the items with the same pharmacology or the same using function into the same classification catalog; the memory has a plurality of memory regions, each memory region is configured as a plurality of memory directories, and each directory is configured with at least one associated directory; storing any single item in each classification catalog under a storage catalog in a storage area, and storing other items with the same pharmacology or using functions as the items in the associated catalog; the index table generation module is used for setting corresponding storage index words for each storage directory and each associated directory based on the basic information, forming a corresponding index table by using the storage index words, in the index table, taking the storage index words corresponding to the items under the storage directory as main index words, taking the storage index words of other items under the associated directory associated with the storage directory as auxiliary index words, and associating the main index words and the auxiliary index words in the associated table; the circulation module is used for calling the attribute setting of the diagnosis report after any doctor client loads the diagnosis report when the diagnosis report of the user is circulated, writing the loading time in the attribute of the diagnosis report, planning a treatment initial scheme by a doctor according to the diagnosis report, associating the initial scheme with the diagnosis report, taking the loading time written in the attribute of the diagnosis report as the identification code of the initial scheme while associating, and sending the initial scheme to the identification module along with the diagnosis report; the consistency recognition module is used for recognizing the recognition code of the initial scheme on one hand and loading the diagnosis report on the other hand after receiving the diagnosis report and the initial scheme related to the diagnosis report, analyzing the loading time recorded in the attribute of the diagnosis report, carrying out consistency verification on the loading time and the recognition code, and inputting the diagnosis report and the initial scheme corresponding to the diagnosis report into an automatic recognition system arranged in the management end server after the verification is passed; the automatic identification system is used for loading an initial scheme, identifying treatment information in the initial scheme, acquiring a plurality of initial scheme items in the treatment information, calling the memory by the automatic identification system, forming index words for searching by using the plurality of initial scheme items according to a set compiling rule in the memory, searching in an index table by using each index word for searching, checking whether the index words for searching have corresponding main index words or auxiliary index words in the index table, if so, acquiring a plurality of items with the same pharmacology or the same use function by using any one of the main index words or the auxiliary index words correspondingly, taking the plurality of obtained items as a combined item to replace the corresponding initial scheme item, if not, reserving the initial scheme item, freely combining the reserved initial scheme item and the obtained combined item according to the set compiling rule, inputting the plurality of treatment schemes into the DRG/DIP system, calculating a plurality of check results, acquiring the corresponding check results by using any one of the main index words or the auxiliary index words, and making the corresponding check results to a corresponding customer account by a doctor after the doctor is calculated, and after the doctor is calculated and ordered to the corresponding check results are calculated, the corresponding to the corresponding check results are calculated and the corresponding to the customer account and the corresponding to the service account and the price.
In the above, the medicines are taken as examples, and the medicines are classified according to whether the pharmacology is the same or not as the classification basis, and the medicines generally have at least one pharmacology, for example, medicines for diminishing inflammation have an analgesic effect, and in the present application, the medicines are classified according to a single pharmacologic effect.
In the above, the storage is provided with a storage guiding unit, and the storage guiding unit is used for storing any one single item under the same category as a storage catalog corresponding to the main index in the storage area, and storing other items with the same pharmacology or the same use function as the item under the same category as an auxiliary index in the associated catalog.
In the above, the compiling module has a first configuration unit, a second configuration unit, and a third configuration unit; wherein the first configuration unit is used for a first configuration taking the name of a single item as basic information; the second configuration unit is used for calculating the price of a single item in the DRG/DIP price calculating system as a second configuration; the third configuration unit is used for taking pharmacology or using functions of the single item as a third configuration.
In the above, the circulation module includes: the synchronous clock unit is used for providing reference clocks for a plurality of doctor clients connected with the management end server and the management end server; the circulation analysis unit is used for analyzing the data transmission between the management end server and the doctor client to judge whether the transmission contains a diagnosis report or not, so as to form a judgment result; the relay selection unit is used for selecting a corresponding receiving and transmitting channel to transmit data based on the judging result; wherein, the data transmission containing the diagnosis report is transmitted by the first receiving and transmitting channel; data transfer without diagnostic report is transferred with the second transceiving channel.
In the above, the doctor client is provided with: the time flow marking unit is used for calling the attribute setting of the diagnosis report after any doctor client loads the diagnosis report, and writing loading time in the attribute of the diagnosis report; an initial plan generation unit for forming a treatment initial plan based on a diagnosis report by a doctor and inputting basic medical resource information forming the initial plan through an externally accessed input device; and the association unit is used for associating the initial scheme with the diagnosis report, and taking the loading time written in the attribute of the diagnosis report as the identification code of the initial scheme at the same time of association.
Further, the attribute of the diagnosis report is a file attribute of the diagnosis report; and, at a doctor client, the file attributes of the diagnostic report are configured to be readable and writable; when a doctor client loads a diagnosis report, the diagnosis report can be edited, for example, diagnosis of a doctor on a disease condition is written in the diagnosis report, and particularly, when the diagnosis is chronic or complex, regular diagnosis is often required according to doctor orders, and the same diagnosis report can be edited for a plurality of times. And when the doctor loads the diagnosis report each time, the loading time is automatically written in the attribute of the diagnosis report, so that whether the diagnosis report is the latest diagnosis report can be judged through distinguishing the loading time.
At the administrative server, the file attributes of the diagnostic report are configured to be readable and non-writable. When the management end server loads the diagnosis report, the content of the diagnosis report can only be read and identified for use, but editing cannot be performed. That is, the diagnostic report is the basis for diagnosis of the disease, so that editing and modification are not possible except for doctors.
Further, the identification module has: the identification unit is used for identifying the identification code of the initial scheme; the consistency verification is used for loading the diagnosis report, analyzing the loading time recorded in the attribute of the diagnosis report and carrying out consistency verification on the loading time and the identification code; the consistency verification is used for judging whether the initial scheme is the latest scheme or not by taking the time flow at the time of circulation as a main line.
Further, the automatic identification system includes: the identification unit is used for loading the initial scheme, identifying the treatment information in the initial scheme and acquiring a plurality of items for the initial scheme in the treatment information; the searching unit is used for calling the memory, forming searching index words by using a plurality of initial scheme items according to a set compiling rule in the memory, and searching in an index table by using each searching index word to check whether the searching index words have corresponding main index words or auxiliary index words in the index table; the judging unit judges whether the initial project is included in the medical insurance category according to the searching result of the searching unit, if so, the corresponding project with the same pharmacology or the same using function is correspondingly obtained by any one of the main index word or the auxiliary index word, the obtained projects are used as a combined project to replace the corresponding initial project, and if not, the project for the initial project is reserved; the combination unit is used for freely combining the reserved initial project items and the obtained combination projects according to a set mode to obtain a plurality of treatment projects; the DRG/DIP pricing system is used for performing multidirectional pricing accounting on a plurality of treatment schemes to form a plurality of pricing accounting results; the recommendation unit is used for comparing the plurality of price accounting results, sorting the price accounting results according to the size of the medical insurance reimbursement amount, compiling the sorted plurality of price accounting results into corresponding price lists, associating the price lists with the corresponding initial schemes, and pushing the associated price lists to doctor clients formulated by the initial schemes by the management end server.
In the above, the DRG/DIP pricing system includes a DRG independent billing mode, a DIP independent billing mode, and a DRG/DIP composite billing mode.
When accounting is carried out, taking DRG independent accounting mode as an example, the combination unit takes the reserved initial project as a necessary option and the combination project as a selectable option, and after the combination project is selected, a mark is correspondingly formed so as to avoid repetition in the next selection. Similarly, considering the possible difference between non-medical insurance categories, in accounting, the reserved initial plan is used as an option, the combined plan is used as an option, the corresponding mark is selected to avoid repeated selection, in this case, the mark is set as a first mark and a second mark, the first mark is used for marking the reserved initial plan, the second mark is used for marking the combined plan, and the first mark or the second mark has a plurality of identical options in the same group of possible options. But in the same recommended version the first mark or the second mark can only appear once at any time.
Based on the existing electronic informatization systems of medicines, instruments and the like, the application reclassifies and stores the items (medicines or medical instruments) of each medical insurance information service in 15 medical insurance information services which can be brought into medical insurance ranges at present, and takes medicines as examples, multiple medicines for treating the same symptoms are stored under the mutually related catalogs according to the same pharmacological action, and an index table is correspondingly formed. After the doctor gives an initial scheme for treatment according to the diagnosis report of the patient, the doctor identifies the initial scheme in the automatic identification system, a plurality of items for the initial scheme in the treatment information are taken, the items for the initial scheme are formed into search words for searching in a memory, whether the items for the initial scheme correspond to the memory or not is checked, if the items for the initial scheme correspond to the memory, the category of medical insurance is included, if the items for the initial scheme do not correspond to the memory, the items for the initial scheme are self-charged items, and then various composite calculation is carried out according to the DRG/DIP pricing system, so that a final recommended medication scheme is obtained for the doctor or the patient to refer to.
Although embodiments of the present invention have been shown and described, it will be understood by those skilled in the art that various changes, modifications, substitutions and alterations can be made therein without departing from the principles and spirit of the invention, the scope of which is defined in the appended claims and their equivalents.
Claims (10)
1. A medical insurance management method based on DRG/DIP is characterized by comprising the following steps:
a memory providing medical insurance management, the memory being arranged into a plurality of storage areas, each storage area being arranged into a plurality of storage directories, and each directory being configured to have at least one associated directory;
configuring basic information for single items under each medical insurance information service according to a set compiling rule, classifying all the items under the same medical insurance information service by using the basic information, classifying the items with the same pharmacology or the same use function into the same classification catalog, storing the corresponding single item in each classification catalog into a storage catalog in a storage area, storing the corresponding single item with the other items with the same pharmacology or the same use function into an association catalog, setting corresponding storage index words for each storage catalog and the association catalog based on the basic information, forming a corresponding index table by using the storage index words, in the index table, using the storage index words corresponding to the items under the storage catalog as main index words, using the storage index words of the other items under the association catalog associated with the storage catalog as auxiliary index words, and associating the main index words and the auxiliary index words in the association table;
When a diagnosis report of a user is circulated, after loading the diagnosis report by any doctor client, the doctor client invokes the attribute setting of the diagnosis report, writes loading time in the attribute of the diagnosis report, and a doctor develops an initial treatment scheme according to the diagnosis report, associates the initial scheme with the diagnosis report, takes the loading time written in the attribute of the diagnosis report as the identification code of the initial scheme while associating, and sends the initial scheme to a management end server along with the diagnosis report;
after receiving the diagnosis report and the initial scheme related to the diagnosis report, the management end server firstly identifies the identification code of the initial scheme, secondly loads the diagnosis report, analyzes the loading time recorded in the attribute of the diagnosis report, carries out consistency verification on the loading time and the identification code, and inputs the diagnosis report and the initial scheme corresponding to the diagnosis report into an automatic identification system arranged in the management end server after the verification is passed;
the automatic identification system loads an initial scheme, identifies treatment information in the initial scheme, acquires a plurality of items for the initial scheme in the treatment information, calls the memory, forms index words for searching in the memory according to a set compiling rule for the plurality of items for the initial scheme, searches each index word for searching in an index table to check whether the index word for searching has a corresponding main index word or auxiliary index word in the index table, and if so, acquires a plurality of items with the same pharmacology or the same using function corresponding to any one of the main index word or the auxiliary index word correspondingly, and the obtained multiple items are used as a combination item to replace the corresponding initial scheme item, if the combination item does not exist, the initial scheme item is reserved, the reserved initial scheme item and the obtained combination item are freely combined according to a set mode to obtain multiple treatment schemes, the multiple treatment schemes are input into a DRG/DIP pricing system to conduct pricing accounting, multiple pricing accounting results are formed, the multiple pricing accounting results are compared, the pricing accounting results are ordered according to the size of the medical insurance reimbursement amount, the ordered multiple pricing accounting results are compiled into corresponding accounting sheets, the accounting sheets are associated with the corresponding initial scheme, and after the association, the doctor client side formulated by the initial scheme is pushed to the management end server.
2. The DRG/DIP-based medical insurance management method according to claim 1, wherein configuring the base information according to the set compilation rules includes:
(1) a first configuration having a name of a single item as basic information;
(2) as a second configuration, accounting of individual items in the DRG/DIP accounting system;
(3) the pharmacologic or usage functions of the individual items are taken as a third configuration.
3. The DRG/DIP-based medical insurance management method according to claim 1, wherein the setting manner is:
all reserved initial schemes are used as fixed options;
any one of the combination items is taken as a selected option, and the fixed option and the selected option are combined.
4. A DRG/DIP-based medical insurance management system, comprising:
a management end server and a plurality of doctor clients connected with the management end server;
the management end server is provided with a memory, a compiling module, a classifying module, an index table generating module, a circulation module, a unification identifying module, an automatic identifying system and a DRG/DIP pricing system; wherein the DRG/DIP pricing system is arranged in the automatic identification system;
the compiling module is used for configuring basic information of single items under the same medical insurance information service according to a set compiling rule;
The classifying module is used for classifying all the items under the same medical insurance information service according to the basic information, and classifying the items with the same pharmacology or the same using function into the same classification catalog;
the memory has a plurality of memory regions, each memory region is configured as a plurality of memory directories, and each directory is configured with at least one associated directory; storing any single item in each classification catalog under a storage catalog in a storage area, and storing other items with the same pharmacology or using functions as the items in the associated catalog;
the index table generation module is used for setting corresponding storage index words for each storage directory and each associated directory based on the basic information, forming a corresponding index table by using the storage index words, in the index table, taking the storage index words corresponding to the items under the storage directory as main index words, taking the storage index words of other items under the associated directory associated with the storage directory as auxiliary index words, and associating the main index words and the auxiliary index words in the associated table;
the circulation module is used for calling the attribute setting of the diagnosis report after any doctor client loads the diagnosis report when the diagnosis report of the user is circulated, writing the loading time in the attribute of the diagnosis report, planning a treatment initial scheme by a doctor according to the diagnosis report, associating the initial scheme with the diagnosis report, taking the loading time written in the attribute of the diagnosis report as the identification code of the initial scheme while associating, and sending the initial scheme to the identification module along with the diagnosis report;
The consistency recognition module is used for recognizing the recognition code of the initial scheme on one hand and loading the diagnosis report on the other hand after receiving the diagnosis report and the initial scheme related to the diagnosis report, analyzing the loading time recorded in the attribute of the diagnosis report, carrying out consistency verification on the loading time and the recognition code, and inputting the diagnosis report and the initial scheme corresponding to the diagnosis report into an automatic recognition system arranged in the management end server after the verification is passed;
the automatic identification system is used for loading an initial scheme, identifying treatment information in the initial scheme, acquiring a plurality of initial scheme items in the treatment information, calling the memory by the automatic identification system, forming index words for searching by using the plurality of initial scheme items according to a set compiling rule in the memory, searching in an index table by using each index word for searching, checking whether the index words for searching have corresponding main index words or auxiliary index words in the index table, if so, acquiring a plurality of items with the same pharmacology or the same use function by using any one of the main index words or the auxiliary index words correspondingly, taking the plurality of obtained items as a combined item to replace the corresponding initial scheme item, if not, reserving the initial scheme item, freely combining the reserved initial scheme item and the obtained combined item according to the set compiling rule, inputting the plurality of treatment schemes into the DRG/DIP system, calculating a plurality of check results, acquiring the corresponding check results by using any one of the main index words or the auxiliary index words, and making the corresponding check results to a corresponding customer account by a doctor after the doctor is calculated, and after the doctor is calculated and ordered to the corresponding check results are calculated, the corresponding to the corresponding check results are calculated and the corresponding to the customer account and the corresponding to the service account and the price.
5. The DRG/DIP-based medical insurance management system according to claim 4, wherein the memory is provided with a storage guiding unit, and the storage guiding unit is configured to store any one single item under the same category as a storage directory corresponding to the main index in the storage area, and store other items under the same category as auxiliary indexes corresponding to other items having the same pharmacology or the same usage function as the items.
6. The DRG/DIP-based medical insurance management system according to claim 4, wherein the compiling module has a first configuration unit, a second configuration unit, and a third configuration unit;
wherein the first configuration unit is used for a first configuration taking the name of a single item as basic information;
the second configuration unit is used for calculating the price of a single item in the DRG/DIP price calculating system as a second configuration;
the third configuration unit is used for taking pharmacology or using functions of the single item as a third configuration.
7. The DRG/DIP-based medical insurance management system according to claim 4, wherein said circulation module comprises:
The synchronous clock unit is used for providing reference clocks for a plurality of doctor clients connected with the management end server and the management end server;
the circulation analysis unit is used for analyzing the data transmission between the management end server and the doctor client to judge whether the transmission contains a diagnosis report or not, so as to form a judgment result;
the relay selection unit is used for selecting a corresponding receiving and transmitting channel to transmit data based on the judging result;
wherein, the data transmission containing the diagnosis report is transmitted by the first receiving and transmitting channel;
data transfer without diagnostic report is transferred with the second transceiving channel.
8. The DRG/DIP-based medical insurance management system according to claim 4, wherein the doctor client is provided with:
the time flow marking unit is used for calling the attribute setting of the diagnosis report after any doctor client loads the diagnosis report, and writing loading time in the attribute of the diagnosis report;
an initial plan generation unit for forming a treatment initial plan based on a diagnosis report by a doctor and inputting basic medical resource information forming the initial plan through an externally accessed input device;
And the association unit is used for associating the initial scheme with the diagnosis report, and taking the loading time written in the attribute of the diagnosis report as the identification code of the initial scheme at the same time of association.
9. A DRG/DIP-based medical insurance management system according to claim 4 or 8, wherein the attribute of the diagnostic report is a file attribute of the diagnostic report;
and, at a doctor client, the file attributes of the diagnostic report are configured to be readable and writable;
at the administrative server, the file attributes of the diagnostic report are configured to be readable and non-writable.
10. The DRG/DIP-based medical insurance management system according to claim 4, wherein the identification module has:
the identification unit is used for identifying the identification code of the initial scheme;
the consistency verification is used for loading the diagnosis report, analyzing the loading time recorded in the attribute of the diagnosis report and carrying out consistency verification on the loading time and the identification code;
the consistency verification is used for judging whether the initial scheme is the latest scheme or not by taking the time flow at the time of circulation as a main line.
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