JP6734329B2 - Medical fee payment management system, medical fee payment management method, program - Google Patents

Description

The present invention relates to a medical care payment management system, a medical care payment management method, and a program.

Patients who go to the medical institution pay the medical fee at the accounting window of the medical institution after medical treatment. It often takes a long time to process the medical bill at the accounting counter, and the patient often waits for a long time. In order to eliminate such inconvenience, a service for resetting medical expenses has been started. It should be noted that Patent Document 1 discloses a technology of a payment system capable of deferring the self-payment of medical expenses. By paying the medical expenses by the postpay, it becomes unnecessary to exchange cash at the accounting window.

Japanese Patent No. 4443946

By the way, the above-mentioned payment of medical expenses is often prepared in the case where a large amount of medical expenses are charged after joining the medical insurance. However, the payment of premiums due to the participation of medical insurance is often abandoned, and there is a demand for a technique for preparing for the payment of more expensive medical expenses with more merit.

Therefore, an object of the present invention is to provide a medical care payment management system, a medical care payment management method, and a program that solve the above problems.

According to the first aspect of the present invention, the medical expense payment management system performs an advance transfer process of performing an advance transfer process of the medical expenses of the contractor to the medical institution account based on the reception of the medical expense request information from the medical institution system. A processing unit, a medical expense collection processing unit that collects the medical expenses from a dedicated account of a financial institution that manages the funds of the contractor after the transfer of the medical expenses to the medical institution account, and the balance of the dedicated account. And a replacement service maintenance determination unit that determines whether or not to stop the medical fee payment management service including the replacement transfer processing of the medical expenses of the contractor to the medical institution account based on whether or not the service maintenance balance. , Are provided.

The medical fee payment management system described above is a part of the membership fee of the service collected from the dedicated account when the service is maintained and the amount indicated by the medical fee bill information exceeds a predetermined amount. Insurance payment for the transfer of the insurance benefit amount from the insurance company based on the payment of the insurance premium to the insurance company to the dedicated account of the contractor whose amount indicated by the medical treatment claim information exceeds a predetermined amount. And a money transfer processing unit.

Further, in the medical care payment management system described above, when the balance of the dedicated account of the contractor is less than the basic balance that is larger than the service maintenance balance, the loan amount that makes the balance of the dedicated account the basic balance is the exclusive loan amount. An automatic loan processing unit for depositing money into an account may be provided.

Further, the above-mentioned medical expenses payment management system uses a reserve processing unit that performs reserve processing for the dedicated account from another account of the contractor, and the interest rate for the balance of the dedicated account higher than the other account, using the balance. And an interest rate management unit that calculates the interest rate of.

According to the second aspect of the present invention, the medical expense payment management method performs advance payment processing of the medical expenses of the contractor to the medical institution account based on the reception of the medical expense request information from the medical institution system, After the transfer of the medical expenses to the medical institution account, the medical expenses are collected from the dedicated account of the financial institution that manages the funds of the contractor, and based on whether the balance of the dedicated account is the service maintenance balance or not. It is characterized by determining whether or not to stop the service of the medical fee payment management including the advance transfer processing of the medical fee of the contractor to the medical institution account.

In the above-mentioned medical expense payment management method, when the service is maintained and the amount indicated by the medical bill request information exceeds a predetermined amount, a part of the membership fee of the service collected from the dedicated account The payment processing of the insurance benefit amount from the insurance company based on the payment of the insurance premium of the insurance company to the insurance company may be performed to the dedicated account of the contractor whose amount indicated by the medical bill information exceeds a predetermined amount. ..

In the above-mentioned medical fee payment management method, when the balance of the dedicated account of the contractor is less than the basic balance that is larger than the service maintenance balance, the loan amount that makes the balance of the dedicated account the basic balance is the dedicated account. You can transfer it to.

In the above-mentioned medical expenses payment management method, the accumulation process from the other account of the contractor to the dedicated account is carried out, and the interest rate of the balance is calculated using the interest rate of the balance of the dedicated account higher than the other account. You can

According to the third aspect of the present invention, the program causes the computer of the medical expenses payment management system to transfer the medical expenses of the contractor to the medical institution account based on the reception of the medical expenses request information from the medical institution system. Advance payment processing means for performing processing, medical fee collection processing means for collecting the medical fee from a dedicated account of a financial institution that manages the fund of the contractor after the medical fee is transferred to the medical institution account, and the dedicated Retention service maintenance that determines whether or not to stop the medical fee payment management service including the above-mentioned transfer processing of the medical expenses of the contractor to the medical institution account based on whether or not the balance of the account is the service maintenance balance It is characterized in that it functions as a judging means.

ADVANTAGE OF THE INVENTION According to this invention, it becomes possible to prepare for the payment of a large amount of medical expenses which has a merit, and it is possible to provide the technology in which there is no need to worry about the payment of medical expenses for a lifetime.

It is a figure which shows the structure of the medical expenses payment management system by one Embodiment of this invention. It is a figure showing an outline of processing of a medical expenses payment management system by one embodiment of the present invention. It is a figure which shows the hardware constitutions of each apparatus contained in the medical expenses payment management system by one Embodiment of this invention. It is a functional block diagram of a medical care payment management server and a financial institution server by one embodiment of the present invention. It is a 1st figure which shows the process flow of the medical care payment management system by one Embodiment of this invention. It is the 2nd figure which shows the processing flow of the medical care payment management system by one Embodiment of this invention. It is a figure showing an outline of loan processing by one embodiment of the present invention. It is a 3rd figure which shows the process flow of the medical care payment management system by one Embodiment of this invention. It is a 4th figure which shows the processing flow of the medical care payment management system by one Embodiment of this invention.

Hereinafter, a medical fee payment management system according to an embodiment of the present invention will be described with reference to the drawings.
FIG. 1 is a diagram showing a configuration of a medical expense payment management system according to the embodiment.
As shown in FIG. 1, in the medical care payment management system 100, a medical care payment management server 1, a financial institution server 2, a medical institution server 3, and an insurance company server 4 are connected via a communication network. The medical fee payment management server 1 is a computer operated by a company that uses the medical fee payment management system 100 to provide main services to patients who are contractors. The financial institution server 2 is a computer operated by a financial institution. The medical institution server 3 is a computer operated by the medical institution. The insurance company server 4 is a computer operated by the insurance company.

FIG. 2 is a diagram showing an outline of processing of the medical expense payment management system according to the present embodiment.
The medical fee payment management service according to this embodiment is provided by a service providing company that operates the medical fee payment management server 1. (1) A contractor who can be a patient makes a contract for the service with a service providing company. This contract allows the contractor to receive medical care payment management service. (2) The contractor who receives the medical fee payment management service opens at least a health account at a financial institution and instructs the financial account to transfer a predetermined monthly reserve amount. The monthly reserve amount may be freely decided by the contractor. Alternatively, the contractor may instruct many deposits to be transferred to the health account at one time. The health account is a dedicated account required to receive the medical fee payment management service. The contractor may separately open an ordinary account at a financial institution and transfer the reserve fund from this ordinary account to the health account. This health account may be an account having a lending function that allows the financial institution to lend the difference in the amount of the difference in the medical treatment cost of the contractor when the amount is higher than the balance of the health account.

(3) Under the above contract, the financial institution will carry out the processing of depositing the reserve fund to the health account of the contractor every month. The deposit source account of the reserve fund may be an ordinary account of the financial institution of the contractor who opened the health account, or an account of another financial institution. The service providing company provides the medical care payment management service when the balance of the health account is equal to or more than the predetermined service maintenance balance. The financial institution may calculate the interest rate by applying the reserve fund managed in the health account based on the above contract to a higher interest rate than the interest rate applied to other accounts.

(4) The service providing company gives an instruction to collect the monthly fee as a consideration for providing the medical fee payment management service. With this, it is possible to instruct the transfer of the monthly membership fee from the health account or the ordinary account to the account of the service providing company. (5) The service providing company instructs the insurance company to pay a predetermined amount of the monthly fee as an insurance premium. Insurance contracts are made between insurance companies and service providers. The insurance contract is a contract of insurance money paid from the insurance company to the service providing company that replaces the medical expenses when the medical expenses of the contractor are higher than a predetermined amount. The service providing company provides a service for paying the insurance money to the contractor in return.

(6) After the contract as described above, the contractor receives medical examination at a medical institution that can use this service. (7) When the patient who has been examined is a contractor, the medical institution directly bills the medical service fee to the service provider company. (8) When the medical institution requests medical fees, the service providing company instructs the payment of the medical fees. As a result, the service providing company can transfer the medical treatment fee from its own account to the account of the medical institution, and recover the medical treatment cost of the contractor who becomes the patient. (9) The service provider company issues a medical fee collection instruction to the financial institution at a later date in order to collect the medical fee. Thereby, the financial institution server transfers the medical expenses from the account of the contractor to the account of the service providing company.

(10) The balance managed by the health account is used as medical expenses, and the balance is reduced. The financial institution automatically lends so that the balance of the health account maintains the basic balance (basic balance> service maintenance balance). (11) When the medical care cost is equal to or higher than a predetermined high amount, the service providing company instructs the financial institution to pay a predetermined stipend. As a result, the financial institution transfers money from the account of the service provider to the health account or ordinary account of the contractor. The insurance contract that the service provider concludes with the insurance company is “contract performance cost insurance”. For this reason, the service provider pays the loss in which the contractor's health account balance is reduced (before receiving the insurance money) as a stipend.

(12) The service provider makes an insurance claim request corresponding to the stipend, based on the contract with the insurance company. (13) The insurance company gives an instruction to the financial institution to the financial institution based on the insurance claim request. As a result, insurance benefits are transferred from the insurance company's account to the service provider's account. (14) The insurance company notifies the service provider that the insurance benefits have been completed.

When the contractor contracts for the medical fee payment management service, the contracting person can receive the medical fee rebuilding service and the service such as stipend payment when the medical fee is high by the above processing. In addition, the contractor can automatically accumulate the specified amount of money in the health account every month when he contracts for the medical fee payment management service. The contractor can cancel the contract for the medical care payment management service in the future, and in this case, the amount accumulated in the health account can be transferred to another account of his/her own and used. Moreover, since the interest rate of the health account is operated at a higher rate than the interest rates of other accounts, by accumulating money in the health account, it is possible to receive services equivalent to or more than the funded medical insurance.

FIG. 3 is a diagram showing a hardware configuration of each device included in the medical expense payment management system.
As shown in the figure, the medical care payment management server 1, the financial institution server 2, the medical institution server 3, and the insurance company server 4 include a CPU (Central Processing Unit) 101, a ROM (Read Only Memory) 102, and a RAM (Random Access). It is a computer provided with each hardware such as a memory) 103, a database 104, and a communication module 105.

FIG. 4 is a functional block diagram of the medical expense payment management server and the financial institution server.
The medical fee payment management server 1 executes a medical fee payment management program stored in advance. As a result, in the medical fee payment management server 1, the control unit 11, the membership fee processing unit 12, the insurance fee management unit 13, the advance payment processing unit 14, the medical fee collection processing unit 15, the insurance benefit transfer processing unit 16, the service maintenance determination. Each functional unit of the unit 17 and the notification unit 18 is provided.
The control unit 11 controls other functional units.
The membership fee processing unit 12 gives an instruction to collect the monthly membership fee required for providing the service.
The insurance premium management unit 13 performs processing relating to an insurance contract to be provided when providing a service.
The advance payment processing unit 14 performs a transfer process or the like for rebuilding the medical expenses.
The medical care cost collection processing unit 15 performs a medical care cost collection process.
The insurance benefit transfer processing unit 16 performs transfer processing when paying the insurance benefit to the contractor as sympathy money.
The service maintenance determination unit 17 performs processing to determine whether or not to stop the medical fee payment management service based on whether or not the balance of the health account is the service maintenance balance.
The notification unit 18 makes various notifications.

The financial institution server 2 executes various processing programs. As a result, the financial institution server 2 is provided with the functions of the control unit 21, the reserve processing unit 22, the transfer processing unit 23, the balance confirmation unit 24, the loan processing unit 25, the interest rate management unit 26, and the notification unit 27.
The control unit 21 controls other functional units.
The reserve processing unit 22 performs a reserve process and a deposit process such as a temporary reserve or a welfare money from the ordinary account to the health account for each contractor. In addition to monthly reserves, there are temporary reserves, sympathy deposits, and high-cost medical treatment deposits.
The transfer processing unit 23 performs transfer processing based on an instruction from another device.
The balance confirmation unit 24 confirms the balance for each contractor.
The loan processing unit 25 automatically performs a loan process for each contractor when the balance of the health account is less than a predetermined basic balance.
The interest rate management unit 26 calculates the interest rate of the balance using the interest rate for the balance of the health account higher than other accounts. The interest rate is, for example, an interest rate applied to the balance of the health account. In yet another example, a high interest rate need not be applied to the health account balance.
The notification unit 27 makes various notifications to a predetermined device.

Note that, for convenience of explanation, the medical expense payment management server 1, the financial institution server 2, the medical institution server 3, and the insurance company server 4 are described as a single server, but different servers operate for each function and these different servers operate. The processing of each server may be performed integrally.

FIG. 5 is a first diagram showing a processing flow of the medical expense payment management system.
Next, the processing flow of the medical fee payment management system will be described step by step.
First, the financial institution server 2 stores information such as an ordinary account number, a health account number, a monthly reserve amount, and a transfer date for the reserve in association with the account ID corresponding to the contractor. Then, the reserve processing unit 22 of the financial institution server 2 transfers the reserve amount from the ordinary account of the contractor to the health account at a predetermined time on the day indicated by the transfer date. As a result, the reserve amount of each contractor is transferred to the contractor's health account.

On the other hand, the medical care payment management server 1 also stores contractor information such as contractor ID, financial institution information, health account number, contractor name, and contractor address for each contractor. Based on the contractor information, the membership fee processing unit 12 of the medical care payment management server 1 provides monthly membership fee collection instruction information including health account numbers of each contractor, financial institution information of those accounts, and account numbers of service providers. To generate. The membership fee processing unit 12 transmits the monthly membership fee collection instruction information to the financial institution server 2 (step S101).

When the financial institution servers 2 of a plurality of financial institutions are included in the medical fee payment management system 100, the membership fee processing unit 12 transmits the membership fee recovery instruction information to the corresponding financial institution server 2 according to the financial institution information. Similarly, when transmitting the other information to the financial institution server 2, the medical expense payment management server 1 transmits the information to a different financial institution server 2 based on the financial institution used by the contractor. The description will be omitted.

The transfer processing unit 23 of the financial institution server 2 performs a process of transferring a predetermined amount of membership fee from the account number of the transfer source contractor indicated by the information to the account number of the service providing company of the transfer destination, based on the membership fee collection instruction information. To do. As a result, the monthly membership fee is paid from the contractor to the service providing company.

The insurance fee management unit 13 of the medical fee payment management server 1 pays a predetermined amount of the monthly fee to the insurance company as an insurance fee. In this case, the insurance premium management unit 13 calculates the total insurance premium corresponding to all the contractors who maintain the service. The monthly membership fee and insurance premium may differ depending on the service level of the contractor. For example, the amount of insurance benefits and provision of other services may differ depending on the service level. The insurance premium management unit 13 further generates insurance premium payment instruction information including the calculated total insurance premium. The insurance payment instruction information includes the account number of the insurance company account as the transfer destination and the account number of the service providing company as the transfer source. The membership fee processing unit 12 transmits the insurance premium payment instruction information to the financial institution server 2 (step S102). The transfer processing unit 23 of the financial institution server 2 performs the transfer processing of the insurance premium from the account number of the service provider company of the transfer source to the account number of the insurance company account based on the insurance premium payment instruction information.

Then, it is assumed that the contractor has a medical examination at a predetermined medical institution. Then, in this medical institution, the medical institution server 3 determines whether the ID of the patient input by the operator is associated with the ID of the contractor of the medical expense payment management service. When the patient ID is associated with the ID of the medical care payment management service contractor, the medical institution server 3 outputs a judgment input screen for determining whether to receive the medical care payment management service to the monitor. When the operator confirms the patient's intention and determines that the patient receives the medical care payment management service, the operator uses the determination input screen output to the monitor of the medical institution server 3 to instruct the service start. Then, the medical institution server 3 generates medical bill request information including the contract ID of the contractor, the medical fee, the medical institution ID, and the like. The medical institution server 3 transmits the medical bill request information to the medical bill payment management server 1.

The medical fee payment management server 1 receives the medical fee billing information (step S103). Then, the advance payment processing unit 14 of the medical fee payment management server 1 reads information such as medical fee, contract ID, medical institution ID, etc. included in the medical fee billing information. The advance payment processing unit 14 reads information indicating service availability/non-availability recorded in a database or the like in association with the contract ID. When the contract ID is associated with the information indicating that the service can be maintained, the advance payment processing unit 14 determines that the medical expense advance will be performed. The advance payment processing unit 14 reads the account number of the medical institution account corresponding to the medical institution ID from the database or the like. The advance payment processing unit 14 reads the account number of the service providing company and the account number of the medical institution account corresponding to the medical institution ID from the database or the like. The advance payment processing unit 14 generates medical expense payment instruction information including at least the medical expenses, the account number of the service providing company that is the transfer source, and the account number of the medical institution account that is the transfer destination (step S104). The advance payment processing unit 14 transmits the medical fee payment instruction information to the financial institution server 2 (step S105). The payment transfer processing unit 14 reads the information indicating whether or not the service can be maintained, which is recorded in a database or the like in association with the contract ID, and as a result, if the information indicating that the service cannot be maintained is associated, the medical fee is replaced. It is determined to cancel. In this case, the advance processing unit 14 instructs the notification unit 18 to notify that the service cannot be maintained. The notification unit 18 reads the network address of the patient (contractor) from the database or the like based on the contract ID, and notifies the network address to the information that the service cannot be maintained. As a result, the contractor transfers an amount such that the balance of the health account exceeds the service maintenance balance. The balance confirmation unit 24 of the financial institution server 2 reads the balance of the health account of the contractor and notifies the medical fee payment management server 1 of the balance. As a result, the service maintenance determination unit 17 of the medical fee payment management server 1 determines whether the service can be maintained or not by the process shown in FIG. 8 below. Details will be described later with reference to FIG.

The financial institution server 2 receives the medical fee payment instruction information. The transfer processing unit 23 performs a transfer process using the transfer source account number, the transfer destination account number, and the transfer fee included in the medical care fee payment instruction information. That is, the transfer processing unit 23 performs transfer processing by subtracting the medical care cost from the balance of the account indicated by the account number of the service providing company and adding the medical care cost to the balance of the account number of the medical institution account. As a result, the service provider company can pay the medical expenses in advance to the medical institution. Note that the interest rate management unit 26 of the financial institution server 2 may calculate the interest rate of the balance by using the interest rate for the balance of the health account higher than other accounts such as the ordinary account.

The medical care fee collection processing unit 15 of the medical care fee payment management server 1 issues a medical care fee collection instruction to a medical fee payment instruction for one month performed by the predetermined day of the previous month on a predetermined day of the next month. The medical care cost collection processing unit 15 totals the medical care costs based on the medical care cost billing information for one month until the predetermined day of the previous month (step S106). Then, the medical treatment fee collection processing unit 15 records a plurality of pairs of medical treatment billing information and medical treatment payment instruction information in the database, and generates corresponding medical treatment fee collection instruction information based on the information (step S107). ). The medical fee collection instruction information is a health account of the contractor corresponding to the contract ID that is the transfer source, based on the pair of the medical fee billing information for one month until the predetermined day of the previous month and the medical fee payment instruction information. At least the account number, the account number of the service providing company as the transfer destination, and the total medical fee. The medical expenses collection processing unit 15 transmits the medical expenses collection instruction information to the financial institution server 2 (step S108). The transfer processing unit 23 of the financial institution server 2 subtracts the medical care cost from the balance of the account number of the health account of the contractor corresponding to the contract ID that is the transfer source, based on the medical care cost collection instruction information, and becomes the transfer destination service. Perform a transfer process that adds medical fees to the account number balance of the provider. As a result, the service providing company can collect the medical expenses recovered by the service providing company. The financial institution server 2 repeats the above process for each contractor.

According to the above-described processing, the contractor who has contracted for the medical fee payment management service provided by the service providing company can open a dedicated account called a health account at a financial institution, and can make a monthly reserve for this health account. Then, the medical fee advance service based on the balance of the health account can be received, and the merit of shortening the waiting time during the accounting procedure at the medical institution can be enjoyed.

In addition, since a monthly reserve is transferred to the health account, if you do not receive medical treatment at a medical institution, you can accumulate the balance of your health account for high medical expenses that may occur in the future and cancel the service. By doing so, it can be used for other purposes.

In addition, when the interest rate given to the balance of the health account is higher than that of other accounts, it is possible to manage the money more effectively by accumulating the money in the health account as compared with the deposit in the other account.

FIG. 6 is a second diagram showing the processing flow of the medical expense payment management system.
FIG. 7 is a diagram showing an outline of the loan processing.
The financial institution server 2 constantly monitors whether or not the balance of the health account is less than the predetermined basic balance. The basic balance is larger than the service maintenance balance. Specifically, the balance confirmation unit 24 reads the balance of the contractor's health account (step S201). The balance confirmation unit 24 outputs the contractor ID, the account number of the contractor's health account, and the balance of the health account to the loan processing unit 25. The loan processing unit 25 compares the balance of the health account with the amount set as the basic balance (step S202). If the balance of the health account is less than the basic balance (FIG. 7(a)), the loan processing unit 25 determines to automatically lend to the contractor (step S203). The loan processing unit 25 calculates a loan amount indicating a difference between the current balance of the health account and the basic balance recommended as the balance of the health account (step S204). The loan processing unit 25 generates loan transfer processing information indicating the loan amount and the health account number (step S205). The loan processing unit 25 outputs the loan transfer processing information to the transfer processing unit 23. The transfer processing unit 23 adds the loan amount to the balance of the account number of the healthy account included in the loan transfer processing unit information, and subtracts the loan amount from the predetermined loan pool account of the financial institution (FIG. 7(b)). Is performed (step S206). Note that the loan processing unit 25 transmits a loan approval/disapproval determination request to the medical expense payment management server 1 when making a loan, and as a result, only when the determination result information indicating the loan availability is received from the medical expense payment management server 1. The loan processing of the loan may be performed.

When the balance of the health account becomes less than the basic balance due to the collection of the large medical expenses by the above process, the contractor can enjoy the automatic lending service. As a result, it is possible to reduce the shortage of the balance in the use of the medical fee advance service using the health account.

FIG. 8 is a third diagram showing the processing flow of the medical fee payment management system.
Whether the medical fee payment management server 1 stops the medical fee payment management service including the transfer processing of the medical fee of the contractor to the medical institution account transfer based on whether the balance of the health account is the service maintenance balance or not. To judge.

Specifically, first, the financial institution server 2 constantly monitors whether the balance of the health account of the contractor is less than the service maintenance balance. The service maintenance balance is smaller than the basic balance as shown in FIG. Specifically, the balance confirmation unit 24 reads the balance of the health account of the contractor. The balance confirmation unit 24 outputs the contractor ID, the account number of the contractor's health account, and the balance of the health account to the reserve processing unit 22. The reserve processing unit 22 compares the balance of the health account with the amount of money set as the service maintenance balance. When the balance of the health account is less than the service maintenance balance, the reserve processing unit 22 transmits the service maintenance determination information to the medical expense payment management server 1. The service maintenance determination information includes the contractor ID and the balance of the contractor's health account.

The service maintenance determination unit 17 of the medical fee payment management server 1 acquires service maintenance determination information (step S301). Based on the contractor ID and the balance of the healthy account included in the service maintenance determination information, the service maintenance determining unit 17 determines that the service cannot be maintained if the balance of the healthy account is less than the service maintenance balance (step S302). Note that the financial institution server 2 may determine whether the service cannot be maintained, instead of the medical fee payment management server 1. In this case, the notification unit 27 of the financial institution server 2 notifies the medical fee payment management server 1 that the service cannot be maintained. The service maintenance determination unit 17 of the medical fee payment management server 1 associates the information that the service cannot be maintained with the contractor ID and registers the information in a database or the like (step S303). As a result, the medical fee advance service is stopped based on the reception of the medical fee request information about the contractor.

FIG. 9 is a fourth diagram showing the processing flow of the medical expense payment management system.
When the service for the contractor is maintained and the amount of money indicated by the medical fee bill information exceeds a predetermined amount, the medical fee payment management server 1 provides insurance for part of the membership fee for the service collected from the health account. The payment processing of the insurance benefit amount from the insurance company based on the payment of the premium to the insurance company is performed to the health account of the contractor whose amount indicated by the medical treatment bill information exceeds the predetermined amount. The process will be described below.

The insurance benefit transfer processing unit 16 of the medical care payment management server 1 acquires the medical care charge request information received from the medical institution server 3 in the above-described processing from the advance payment processing unit 14 that has completed the medical care payment processing. The insurance benefit transfer processing unit 16 reads the medical care cost included in the medical care cost request information (step S401). The insurance benefit transfer processing unit 16 determines whether the medical care cost is equal to or higher than a predetermined high amount (step S402). When the medical treatment cost is equal to or higher than a predetermined high amount, the insurance benefit transfer processing unit 16 determines that the stipend is transferred to a health account that can be specified based on the medical treatment request information and the insurance benefit request is made ( Step S403).

In this case, the insurance benefit transfer processing unit 16 of the medical expense payment management server 1 determines the predetermined high amount of money as sympathy money if the medical expense included in the medical expense request information is equal to or higher than the predetermined high amount of money. Further, the insurance benefit transfer processing unit 16 determines the medical treatment fee as a welfare money if the medical treatment cost included in the medical treatment request information is less than a predetermined high amount. The insurance benefit transfer processing unit 16 generates sympathy payment information indicating the determined amount of sympathy money. The sensation payment instruction information further includes information such as the account number of the transfer-destination health account identified based on the contractor ID and the account number of the transfer-source service provider company. The insurance benefit transfer processing unit 16 transmits the stipend payment instruction information to the financial institution server 5 (step S404).

The transfer processing unit 23 of the financial institution server 5 receives the stipend payment instruction information. The transfer processing unit 23 subtracts the amount of money from the balance of the account number of the service provider of the transfer source, and adds the amount of money to the balance of the account number of the transfer destination health account, based on the money payment instruction information. As a result, the transfer processing unit 23 can pay the welfare money from the service providing company to the contractor.

Then, the insurance benefit transfer processing unit 16 starts the insurance benefit request processing according to the payment of the stipend. Claims for insurance benefits are made based on the insurance contract between the service provider and the insurance company. The insurance contract is a contract to treat as an insurance accident when the medical expenses of a predetermined high amount or more occur. The insurance payment transfer processing unit 16 generates insurance payment request information (step S405). The insurance benefit transfer processing unit 16 transmits the insurance benefit claim information to the insurance company server 4 (step S406). The insurance benefit request information includes medical expenses, contractor ID, medical institution ID received by the contractor, account number of the service providing company, and the like.

The insurance company server 4 receives the insurance benefit claim information. The insurance company server 4 performs a predetermined examination process based on the insurance benefit claim information. When the examination process is completed and the insurance benefit is determined, the insurance company server 4 generates the insurance benefit instruction information. The insurance benefit instruction information includes the insurance benefit, the account number of the transfer source insurance company account, the account number of the transfer destination service provider, and the like. The transfer processing unit 23 generates insurance benefit payment instruction information. The transfer processing unit 23 subtracts the insurance benefit amount from the balance of the account number of the insurance company account based on the insurance benefit instruction information, and adds the insurance benefit amount to the account number of the service providing company. This completes the payment of insurance benefits from the insurance company to the service provider. When the insurance company server 4 completes the transmission of the insurance benefit payment instruction information, it generates insurance benefit payment notification information. The insurance benefit notification information includes information such as medical expenses and contractor ID included in the insurance benefit claim information. The insurance company server 4 transmits the insurance benefit notification information to the medical expenses payment management server 1.

The medical expenses payment management server 1 receives the insurance benefit notification information (step S407). The insurance benefit transfer processing unit 16 of the medical expenses payment management server 1 performs an insurance transfer confirmation process based on the receipt of the insurance benefit notification information (step S408). The insurance money transfer confirmation process is a judgment as to whether or not there is a money transfer corresponding to the insurance money included in the insurance benefit notification information in the account number of the service providing company.

Through the above processing, the contractor who has contracted for the medical fee payment management service can automatically enjoy the service of receiving the stipend when the medical fee is high. The medical care fee payment management server 1 may automatically perform the procedure for requesting a high medical treatment fee when the medical treatment cost is high according to the contract level of the contractor. High medical expenses are benefits provided by, for example, the National Health Insurance Association, which is a public institution. For example, the medical fee payment management server 1 stores contractor information, medical expenses, medical institution information, etc. in necessary entry items of predetermined format data based on contractor information, medical expenses, medical institution information, etc. The written high-cost medical care bill is generated. The medical fee payment management server 1 performs a process of transmitting or outputting the information of the high-cost medical treatment bill document to a predetermined device. For example, the medical care payment management server 1 may output this high-cost medical care bill document to a printing device and print it. The high-cost medical treatment bill document is sent to the high-cost medical treatment billing counter. As a result, the contractor can receive the public high-cost medical care benefits according to the contract level without the effort of preparing and sending the high-cost medical care bill document when the medical care cost is high.

Each person has difficulty predicting their future health status. For this reason, it is often the case that medical insurance is taken out to prepare for medical expenses in the event of a major illness in the future. However, according to the above-mentioned medical expenses payment management system, it is possible to prepare for future payment of medical expenses by accumulating self-fund in a monthly health account without taking out medical insurance. In many cases, medical insurance is a disbursement of premiums, but most of the premiums do not flow back to themselves, but the medical care payment management system described above leaves the balance of the health account at hand and uses it for various necessary funds after retirement. be able to.

In other words, according to the above-mentioned medical expenses payment management system, the living expenses account of a general household and the medical expenses payment account are clearly separated, and the amount equivalent to the amount of medical insurance premiums that are abandoned is accumulated monthly so that medical insurance does not cover. If medical expenses are high, including daily medical expenses, by providing a dedicated medical expense payment account (health account) with insurance and a borrowing function, you can worry about medical expenses for a lifetime. It is possible to provide a technology to be resolved.

Each server described above has a computer system inside. A program for causing each server to perform the above-described processing is stored in a computer-readable recording medium of the server, and the above-described processing is performed by the computer of the server reading and executing the program. Be seen. Here, the computer-readable recording medium refers to a magnetic disk, a magneto-optical disk, a CD-ROM, a DVD-ROM, a semiconductor memory, or the like. Further, the computer program may be distributed to the computer via a communication line, and the computer that receives the distribution may execute the program.

Further, the program may be for realizing a part of the function of each processing unit described above. Further, it may be a so-called difference file (difference program) that can realize the above-mentioned functions in combination with a program already recorded in the computer system.

100... Medical fee payment management system 1... Medical fee payment management server (computer system of service provider company)
2... Financial institution server (financial institution computer system)
3... Medical institution server (medical institution computer system)
4... Insurance company server (insurance company computer system)
11, 21... Control unit 12... Membership fee processing unit 13... Insurance premium management unit 14... Advancement transfer processing unit 15... Medical expense collection processing unit 16... Insurance benefit transfer processing unit 17... Service maintenance determination unit 18, 27... Notification unit 22... Reserve processing unit 23... Transfer processing unit 24... Balance confirmation unit 25... Loan processing unit 26... Interest rate management Department

Claims (9)

A replacement transfer processing unit that performs a transfer transfer processing of the medical expenses of the contractor to the medical institution account based on the reception of the medical bill request information from the medical institution system,
A medical expense collection processing unit that collects the medical expenses from a dedicated account of a financial institution that manages the funds of the contractor after the transfer of the medical expenses to the medical institution account,
A service for determining whether or not to stop the medical fee payment management service including the advance payment processing of the medical expenses of the contractor to the medical institution account based on whether the balance of the dedicated account is a service maintenance balance A maintenance determination unit,
A medical expense payment management system that includes When the service is maintained and the amount indicated by the medical bill information exceeds a predetermined amount, payment of a part of the membership fee of the service collected from the dedicated account to the insurance company An insurance benefit transfer processing unit that performs the transfer processing of the insurance benefit amount from the insurance company based on the above, to the dedicated account of the contractor whose amount indicated by the medical bill request information exceeds a predetermined amount,
The medical fee payment management system according to claim 1, further comprising: An automatic loan processing unit for transferring to the dedicated account a loan amount in which the balance of the dedicated account becomes the basic balance when the balance of the dedicated account of the contractor is less than the basic balance that is greater than the service maintenance balance.
The medical expense payment management system according to claim 1 or 2, further comprising: A reserve processing unit that performs reserve processing from the other account of the contractor to the dedicated account,
An interest rate management unit that calculates an interest rate of the balance using the interest rate of the balance of the dedicated account higher than the other account,
The medical care payment management system according to any one of claims 1 to 3, further comprising: Based on the reception of the medical bill request information from the medical institution system, the transfer processing of the medical expenses of the contractor to the medical institution account is performed,
After the transfer of the medical expenses to the medical institution account, the medical expenses are collected from a dedicated account of a financial institution that manages the funds of the contractor,
Based on whether or not the balance of the dedicated account is the service maintenance balance, it is determined whether or not to stop the service of the medical fee payment management including the advance payment processing of the medical fee of the contractor to the medical institution account. Expense payment management method. When the service is maintained and the amount indicated by the medical bill information exceeds a predetermined amount, payment of a part of the membership fee of the service collected from the dedicated account to the insurance company The medical care payment management method according to claim 5, wherein the transfer processing of the insurance benefit amount from the insurance company based on the above is performed for the dedicated account of the contractor whose amount indicated by the medical treatment claim information exceeds a predetermined amount. .. The loan amount that makes the balance of the dedicated account the basic balance when the balance of the dedicated account of the contractor is less than the basic balance that is greater than the service maintenance balance is transferred to the dedicated account. The medical fee payment management method described in. The accumulation processing from the other account of the contractor to the dedicated account is performed,
The medical expense payment management method according to any one of claims 5 to 7, wherein the interest rate of the balance is calculated using the interest rate of the balance of the dedicated account higher than that of the other account. Computer of medical care payment management system,
Advance payment processing means for performing advance payment processing of the medical expenses of the contractor to the medical institution account based on the reception of the medical expenses request information from the medical institution system,
After the transfer processing of the medical care cost to the medical institution account, the medical care cost recovery processing means for recovering the medical care cost from a dedicated account of a financial institution managing the funds of the contractor,
Advancement for determining whether or not to stop the medical fee payment management service including the advance payment processing of the medical expenses of the contractor to the medical institution account based on whether the balance of the dedicated account is the service maintenance balance Service maintenance determination means,
A program to function as.

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