JP2000123087A - System for managing care service use cost and upper limit insurance payment sum - Google Patents

Abstract

PROBLEM TO BE SOLVED: To manage payment within an upper limit payment sum by providing the information of costs actually spent in a job care site where a patient who needs a care service and the family are present, and to properly grasp the sum of costs to be shared at the time of selecting a service to be added within the upper limit payment sum of the following proper care and at the time of using a service beyond the upper limit sum. SOLUTION: Data are coded by each service unit reserved by a care manager, service unit costs or the related information is added to the data by each service unit, and registered in a data base. Then, the data are shared between the care manager and an equipment at the side of a patient who needs care by using a network system so that the schedule of the care plans can be displayed and costs to be spent on the use of the services are calculated and displayed by the information equipment on the side of the patient who needs care.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION The present invention relates to a list of the amount and contents of nursing care services used by the elderly and their families at home for a certain period of time, and the status of expenses paid, in units of scheduled services. By providing a screen structure and interface that increases the efficiency of checking the remaining amount of available services by comparing with the maximum amount of service that can be used for insurance by accumulating service costs for a certain period by grasping in the schedule format The care manager or self-created care plan creates a reservation management system that adds information on costs for each service required by the care-requiring person. The present invention relates to a method for easily grasping the balance.

[0002]

2. Description of the Related Art In a public long-term care insurance system, the amount of use of a long-term care service is set by an upper limit of insurance payment based on a payment limit individually set according to the degree of need for nursing care.

[0003] The management of the upper limit of insurance payment is performed by the National Health Insurance Federation in a lump sum examination and payment process, and the upper limit is calculated for each individual, so that it can be ascertained only about three months after the date of use. .

[0004] Therefore, in most cases, the care manager makes an appointment for necessary services for each individual requiring care, formulates a service use plan (care plan) within the maximum amount of benefits, and sets a service plan within a certain period. Quantitative management will be performed on whether the service usage is within the upper limit of insurance benefits. A settlement method corresponding to the upper limit management is disclosed in Japanese Patent Application Laid-Open No. 09-101989, which is a card system for long-term care insurance.

[0005]

In the above prior art,
All the cost management of the service will be left to the care manager, insurer, and screening payment agency, and the user will inevitably use the service booked by the care manager and will not have sufficient coordination with the care manager In the event that a service that is not scheduled in a care plan is used temporarily, such as in the case of an accident, there is a disadvantage in that the entire cost must be paid by the user. This point is not mentioned in the above-mentioned care insurance card system.

In addition, since the care manager has a plurality of care recipients and has a heavy burden of responding to communication adjustments such as changing or canceling their own reservations, it is necessary to manage the upper limit of a sufficient amount of payment for all of them. It is difficult to enforce.

[0007] According to the present invention, even at a care site such as a care-requiring person or a family in need of a care service, expenditure management within the upper limit of the amount of care, such as how much care cost actually took at the present time, is performed. For proper future nursing care or for the care of the caregiver, etc., properly understand the amount of services that you want to add within the upper limit of benefits and the cost burden when using services beyond the limit. Providing a method that facilitates information sharing between the user and the care manager can be promoted. In addition, the service reservation adjustment work between the user and the business, which is a burden on the care manager, is made more efficient.

[0008]

Means for Solving the Problems Normally, the contents of a care plan exchanged on a paper basis between a user and a care manager are described in the present invention by an information system device comprising a terminal input device, a data storage device, and various control programs. Is input into the schedule format list for each unit of the reserved service described in the care plan. Based on this, a code is created for each reserved service unit, and information on the service unit price and other costs is added to each code and registered in the database.

[0009] Further, by sharing the data with the user's device in the network system, the user's information device calculates and displays the schedule of the nursing care service on the care plan and the cost required for use. .

In addition, the care manager manages the coded reservation service in such a manner that the care manager secures the service use frame, and the care use person A requests the service at the time and date for the surplus service use frame due to the change of the date and time. An appointment adjustment work such as turning to the care recipient B is controlled by the information device.

[0011]

Embodiments of the present invention will be described below in detail.

FIG. 1 is a block diagram showing the configuration of a system including a network with a care recipient, a care manager input terminal, a plurality of care recipients, and a service provider, which are terminals according to the present invention.

FIG. 2 shows an embodiment of the present invention in which a care manager reserves a service for a care plan of a care-requirer A and applies the present invention to the provision of information for managing the use of services within the upper limit of the amount of benefit. It is a flowchart which shows a form.

FIG. 3 is a flowchart showing an embodiment of a processing procedure in the case where the reservation service secured by the care manager is adjusted among the care-requirers.

FIG. 4 is an explanatory diagram of a reservation service database which manages services reserved by the care manager by coding them with identification codes, and FIG. 5 shows codes of various home care services common to the care insurance system. It is a table figure of the ID information of a service provider, and the unit price of various home care services. FIG. 6 is an explanatory diagram of an example of a data format of care plan information created and transmitted for each care recipient. FIG. 7 is an example of a screen configuration when referring to a service use cost based on a care plan on a device on the care recipient side.

In FIG. 1, reference numeral 100 denotes a system device configuration on the care manager side. The service reserved by the service provider to create a care plan for care recipients is identified by an identification code, assigned to each person requiring care as a service unit of the care plan, the service cost for a certain period is calculated, and the equipment on the care recipient side is calculated. The central processing unit 120, the output unit 130, the input unit 140, the data storage unit 150, and the communication control unit 1
60 and a memory 110. The output device 130 is C
The RT display and the input device 140 are realized by a keyboard, a mouse, and the like. The data storage device 150 is realized by a recording device such as a magnetic recording device or a hard disk. The communication control devices 160 and 181 are devices that manage communication between the equipment on the care manager side and the equipment on the care recipient side and the service provider side.

At 100, a control program 111 for managing devices and programs in the system, an identification code numbering unit 112 for generating an identification code, and a service utilization program for calculating a service utilization cost are stored in a memory 110. A cost calculation unit 113, a communication information control unit 114 which is a program for controlling communication with care-requirers and devices on the service provider side, and a program for collating the care plan creation status among the care-requirers and changing the movement. A service reservation information collation unit 115 and a care plan information recording unit 116, which is a program for recording information on services reserved for each care-requiring person, are stored.

The information communication network 170 with a plurality of care recipients and service providers is, for example, the Internet or a dedicated line or a general line provided by various communication companies. Reference numeral 180 denotes a system device configuration on the care recipient side, and reference numeral 190 denotes a device configuration on the service provider side.

In FIG. 2, when the care manager inputs the date and time of the reserved care service, the service name, and the service provider name through the input device 140 and the output device 130, the identification code numbering section 112 stores the service attribute information. The service type code (511 in FIG. 5) is acquired from the service name code table (510 in FIG. 5) of the unit 152, and the service identification code (511 in FIG. 5) is obtained based on a preset numbering scheme using date data and a serial number. (401 in FIG. 4)
Generate For each generated service identification code, a service code (40 in FIG. 4) is stored in the service property code table (520 in FIG. 5) of the service attribute information storage unit 152.
2), the service name (403 in FIG. 4) from the service name code table (510 in FIG. 5), the date (404 in FIG. 4) of the service input by the input device 140, and the time zone classification (405 in FIG. 4). ) Is acquired, and a reservation record is created in the reservation service table storage unit 151.

In 201, the service use cost calculation unit 11
The service type code acquired at 200 in FIG.
Based on (511) and the business code (521 in FIG. 5), the business unit price table (530) is searched, and the unit price information (405 in FIG. 4) of the service corresponding to each identification code is acquired.

At 202, the care manager operates the input device 1
4 and the output device 130, the care recipient number (40 in FIG. 4) for each reservation service according to the care plan of the care recipient.
6) is assigned.

At 203, the care manager is the care recipient A
It is confirmed whether or not the service allocation for a certain period of has been completed, and if not completed, the process proceeds to 202; if completed, the process proceeds to 204.

At 204, the care manager operates the input device 1
When the start date and the end date of a certain period to be calculated as the care-requiring person number (406 in FIG. 4) and the end date are calculated through the output device 40 and the output device 130, the care plan information recording unit 116 stores the reservation service table in the reservation service table storage unit 151. (400 in FIG. 4) from the care recipient number of care recipient A (40 in FIG. 4)
The reservation service record for an arbitrary period is selected according to 6), and the care plan table of care recipient A (600 in FIG. 6).
Is generated and stored in the care plan table storage unit 153.

In 205, the communication information control unit 114 acquires the address of the care recipient A (541 in FIG. 5) from the care recipient ID table (540 in FIG. 5). The data of the care plan table (600 in FIG. 6) is transmitted to the communication control device 160 and the information communication network 1
The data is transmitted to the device 180 on the care recipient side via 70.

At 206, the transmitted data of the care plan table (600 in FIG. 6) of the care-requiring person A is received by the communication control device 181, and the care program table (FIG. 600)
(601 in FIG. 6) and time zone classification (60 in FIG. 6)
The position on the screen is acquired from 2), a list of care plans (710 in FIG. 7) is displayed on the output device 184, the unit price (603 in FIG. 6) is added, and the cost of using the nursing service (FIG. 6) 7 720) and the amount of self-paid use (73 in FIG. 7).
0) is similarly displayed.

In step 207, the care-requiring person and his / her family or the like are provided with the service schedule in the care plan list (710 in FIG. 7) displayed on the output device 184, the cost (720 in FIG. 7) for using the nursing service, and the payment. The status of the balance remaining up to the upper limit and the copayment amount (730 in FIG. 7) are checked, and the process transitions to 210 when the service usage content of the care plan is changed, and to 208 when the service plan is approved without the change.

At 208, the care-requiring person and the family member thereof approve the care plan information displayed by the output device 184 and the input device 185 with the reservation approval button (750 in FIG. 7) on the screen. Table (60 in FIG. 6)
The data of 0) is stored in the data storage device 186, and the approval information is transmitted to the care manager side device 100 via the communication control device 181 and the information communication network 170 by the control program 183.

At 209, the approval information from the care-requirer A is transferred to the control program 111 of the device 100 on the care manager side.
And the approval information is stored in the care plan table storage unit.

At 210, the care-requiring person and the care-requiring person and their families are judged based on the result of the service use schedule and the remaining amount of the upper limit of the payment at 207, and the date and time of the reservation are changed, the reservation is canceled, and the reservation is added. By selecting the corresponding service area (711 in FIG. 7) of the care plan information displayed on the screen by the output device 184 and the input device 185, the control program 183 causes the date (601 in FIG. 6) and the time zone classification. (602 in FIG. 6). In the case of cancellation, the service identification code (6 in FIG. 6) of the care plan table (600 in FIG. 6) is pressed with the cancel reservation button (760 in FIG. 7).
04), and in the case of adding a reservation, a reservation request (7 in FIG. 7)
By pressing (70), the service identification code (60 in FIG. 6) is displayed.
A new record having a value of (4) of (999999-9999-999) is created, and a change information record (610 in FIG. 6) is transmitted to the device 100 on the care manager side.

At 211, the change information from the care-requirer A is transferred to the control program 111 of the device 100 on the care manager side.
And the change information is stored in the care plan table storage unit 153.

At 212, adjustment is made as to whether the change information from the care recipient A is to be returned to the service reservation of another care recipient. FIG. 3 is a flowchart showing an embodiment of a processing procedure in a case where a reservation service secured by a care manager is canceled and a transfer to another care recipient is required. is there.

Reference numeral 301 denotes a service identification code (60 in FIG. 6) stored in the care plan table storage unit 153 in which the control program 111 stores the change information transmitted from the care recipient A.
4) and the number of care recipients (605 in FIG. 6) are acquired. In the case of canceling the reservation, the data of the care recipient number (406 in FIG. 4) in the reservation service table storage unit is converted to (9999999999), and the reservation is added. In the case of, the service identification code (60 in FIG. 6)
4) Create a record whose data value is (999999-9999-999).

Reference numeral 302 denotes a service reservation information collating unit 115
The value of the service identification code (604 in FIG. 6) in the reservation service table (400 in FIG. 4) is (999999-9999-
Search for the record of 999) and display the care recipient number with the reservation addition request on the screen.

Reference numeral 303 denotes the input device 1
The reservation cancellation record and the reservation addition record in the reservation service table (400 in FIG. 4) are searched through the 40 and the output device 130, and the reservation service to the care-requiring person according to the care plan is performed in the same manner as the steps 202 and 203. Make an assignment. If the request matches another use request, the process proceeds to 304; otherwise, the process proceeds to 305.

Reference numeral 304 denotes the input device 1
By the record operation of the reservation service table (400 in FIG. 4) through the 40 and the output device 130, the reservation service canceled by the care-requiring person A whose date (403 in FIG. 4) and time zone division (404 in FIG. 4) match. Is transferred to the care-requiring person n who desires the service.

In step 305, if the service canceled by the care-requirer A cannot be transferred to another care-requirer, the care manager notifies the service provider of the information on the cancellation of the reservation.

In step 306, when the care-requiring person A desires an additional service, the care manager makes a transfer by adjusting the steps 303 and 304 or makes a reservation for a new service in the same step from the step 200, and sets the additional service. Assignment, and transition to 204 in FIG.

[0038]

[Effect of the Invention] By sharing information with the care manager and realizing cost management for use of various types of services from a plurality of businesses, management of service use within the upper limit of the public nursing care insurance system, It is possible to grasp and manage the total service cost when services exceeding the upper limit of the public system are required.

Further, the care manager can manage the reserved services by assigning a code to each unit frame and managing them, so that the movement of the reserved services can be adjusted between the care-requirers, and between the business operator and the care-requirers. It is possible to suppress the occurrence of change / cancellation of reservations, and to improve the efficiency of office work.

[Brief description of the drawings]

FIG. 1 is a block diagram of a device configuration according to the present invention.

FIG. 2 is a flowchart showing one embodiment of the procedure of the present invention on the care recipient side.

FIG. 3 is a diagram showing a procedure 1 on the care manager side of the processing procedure of the present invention.
5 is a flowchart illustrating an embodiment.

FIG. 4 is an explanatory diagram showing an example of data for managing, in a database, the assignment status of services reserved by a care manager to care recipients;

FIG. 5 is a data example of a service type code, a company ID information, a service unit price, and a care-requirer ID information required for a care manager to code and manage a service reserved from a service provider for each unit frame; FIG.

FIG. 6 is an explanatory diagram illustrating an example of data of a care plan transmitted to a care recipient.

FIG. 7 is an explanatory diagram showing an example of a screen displayed in a list format on a device on the care recipient side.

[Explanation of symbols]

100: System equipment configuration on the care manager side, 1
10: memory, 111: control program, 112: identification code numbering section, 113: service use cost calculation section,
114: communication information control unit, 115: service reservation information collation unit, 116: care plan information recording unit, 120:
Central processing unit, 130 ... output device, 140 ... input device, 150 ... data storage device, 151 ... reservation service table storage unit, 152 ... service attribute information storage unit, 153 ... care plan table storage unit, 160 ...
Communication control device, 170: information communication network 1
70, 180: System equipment configuration on the care recipient side,
181, communication control device, 182, memory, 18
3. Control program 184 Output device 185
Input device 186 Data storage device 190 System equipment configuration on service provider side 400 Reservation service table 510 Service name code table 520 Service provider code table 53
0: unit price table by company; 540: ID table for care recipients; 600: care plan table; 710: list of care plans displayed on the screen; 720: cost of using the nursing service; 730: self-pay Usage amount, 750: reservation approval button, 760: reservation cancellation button, 770: reservation request button

Claims (1)

[Claims] The present invention is based on the sharing of information with a care manager on caregivers such as the elderly and families who need nursing care because they are bedridden or demented due to illness or disability due to aging. Register and output the maximum amount of benefits to be paid for insurance under the public long-term care insurance system and the cost of nursing care services to be used in a list, and manage the amount of care service usage costs and insurance benefits system.