Specific embodiment
Below in conjunction with the attached drawing in the embodiment of the present application, technical solutions in the embodiments of the present application carries out clear, completeSite preparation description, it is clear that described embodiments are only a part of embodiments of the present application, instead of all the embodiments.It is based onEmbodiment in the application, it is obtained by those of ordinary skill in the art without making creative efforts every otherEmbodiment shall fall in the protection scope of this application.
The description and claims of this application and term " first " in above-mentioned attached drawing, " second " etc. are for distinguishingDifferent objects, are not use to describe a particular order.In addition, term " includes " and " having " and their any deformations, it is intended thatIt is to cover and non-exclusive includes.Such as the process, method, system, product or equipment for containing a series of steps or units do not haveIt is defined in listed step or unit, but optionally further comprising the step of not listing or unit, or optionally also wrapInclude other step or units intrinsic for these process, methods, product or equipment.
" embodiment " mentioned in this application is it is meant that a particular feature, structure, or characteristic described can be in conjunction with the embodimentsIncluded at least one embodiment of the application.The phrase, which occurs, in each position in the description might not each mean phaseSame embodiment, nor the independent or alternative embodiment with other embodiments mutual exclusion.Those skilled in the art are explicitlyImplicitly understand, embodiments described herein can be combined with other embodiments.
Electronic device involved by the embodiment of the present application may include the various handheld devices with wireless communication function,Mobile unit, wearable device calculate equipment or are connected to other processing equipments and various forms of radio modemUser equipment (user equipment, UE), mobile station (mobile station, MS), terminal device (terminalDevice) etc..For convenience of description, apparatus mentioned above is referred to as electronic device.
In order to better understand a kind of regulation method provided by the embodiments of the present application, prosecutor method is exchanged first below and carries out letterIt introduces.Referring to Fig. 1, Fig. 1 provides a kind of application scenarios schematic diagram of regulation method for the embodiment of the present application.Such as Fig. 1 instituteShow, medicare system 101 obtains the medical insurance policies and medical expense of target cities 102, and medical expense includes each in target citiesThe medical expense of hospital, medicare system 101 submit an expense account each hospital in ratio and target cities according to the policy in medical insurance policiesMedical expense, come determine target cities medical expense policy reimbursed sum, medicare system 101 using target cities doctorThe medical expense of each hospital in the policy reimbursed sum for the treatment of expense and target cities, calculates the medical expense of target citiesPractical reimbursement ratio, if medicare system 101 judge policy reimbursement ratio and practical reimbursement ratio between difference be higher than in advanceIf reimbursement proportional difference determine the doctor of target cities 102 then according to the practical reimbursement ratio of the medical expense of target citiesProtect policy simulation and regulate and control method, medicare system 101 according to medical insurance policies simulation regulation method to the medical insurance policies of target cities intoRow simulation regulation, wherein medicare system obtains the medical insurance policies of target cities and medical expense and can be carried out by electronic deviceIt obtains, with this, medical insurance policies is regulated and controled by artificial mode relative to existing, can be promoted to a certain extent to doctorTimeliness and accuracy when guarantor's policy regulates and controls.
Referring to Fig. 2, Fig. 2 provides a kind of flow diagram of regulation method for the embodiment of the present application.As shown in Fig. 2,Regulation method includes step 201-205, specific as follows:
201, the medical insurance policies of target cities are obtained, and obtain the medical expense of the target cities, the target cityThe medical expense in city includes the medical expense of each hospital in the target cities.
Wherein, target cities for example can be the city for needing to carry out Medical Insurance Policies regulation, specifically for example can be,In a practical situation, the city for needing to carry out Medical Insurance Policies regulation is the lower city of average value of actual medical reimbursement,The range of normal value of medical treatment reimbursement for example can be the value between 70%-85%, then the lower city of average value of medical treatment reimbursementCity for example can be the city for being lower than medical treatment 10% or more lower limits of normal of reimbursement, i.e. the average value of medical treatment reimbursement is lower than 60%City.
Optionally, the medical expense of target cities can also be that the city portrait of target cities, city portrait are understood thatMedical expense etc. for the medical expense structure of target cities, in each period.
Optionally, medical insurance policies may include policy reimbursement ratio and reimbursement range, specifically, policy reimbursement ratio includes livingRatio, outpatient service reimbursement ratio, specific drugs reimbursement ratio etc. are submitted an expense account by institute；Reimbursement range may include the type structure of allowable drugAt range.
Optionally, the medical expense of target cities can be generated total payment for medical care in the city in a period of timeWith can be the sum of the total medical expense of each hospital whithin a period of time in target cities；Each hospital in target citiesThe total cost that can be generated in terms of medical treatment for each hospital in a period of time of medical expense, for example, it may be some seasonThe medical expense generated in degree is also possible to the medical expense of generation every month, is also possible to the medical expense generated every year, canTo make different selections according to practical situation.
It optionally, include medical insurance reimbursement ratio, medical insurance drug, non-medical insurance drug etc. in medical insurance policies.
202, the payment for medical care of each hospital in ratio and the target cities is submitted an expense account according to the policy in the medical insurance policiesWith determining the policy reimbursed sum of the medical expense of the target cities.
Optionally, medical expense includes the medical insurance reimbursement ingredient amount of money, a kind of medical expense of possible determining target citiesThe method of policy reimbursed sum include step A1-A3, it is specific as follows:
The ingredient amount of money is submitted an expense account in A1, the medical insurance extracted in the target cities in the medical expense of each hospital；
Wherein, the medical insurance reimbursement ingredient amount of money may include reimbursed sum, outpatient service reimbursed sum, specific drugs reimbursed sum in hospitalDeng.
A2, the medical insurance reimbursed sum ingredient in the medical expense of each hospital is submitted an expense account into ratio multiplied by the policy,Obtain the policy reimbursed sum of the medical expense of each hospital；
Optionally, medical expense has medical insurance reimbursed sum ingredient and non-medical insurance reimbursed sum at being grouped as.
A3, the payment for medical care by the sum of policy reimbursed sum of medical expense of each hospital as the target citiesPolicy reimbursed sum.
Optionally, the political affairs by the sum of policy reimbursed sum of the medical expense of each hospital as target cities medical expensePlan reimbursed sum more can completely reflect the policy reimbursed sum of target cities, certainly due to target to a certain extentThere can also be medical insurance fixed point pharmacy etc. in city, then the policy for the drug sold in medical insurance fixed hospital can also be submitted an expense accountThe amount of money is added in the policy reimbursed sum of the medical expense of target cities.
Optionally, the method for the policy reimbursed sum of another medical expense for determining target cities includes step B1-B4,It is specific as follows:
B1, the medication collection for extracting each hospital, the medication collection includes medical insurance drug；
Wherein, the medication collection for extracting hospital can be extracted by the medication inventory of hospital.
B2, obtain each hospital medical insurance drug Sales Volumes；
B3, the Sales Volumes of the medical insurance drug of each hospital are submitted an expense account into ratio multiplied by the policy, obtained describedThe policy reimbursed sum of each hospital；
B4, the policy report by the sum of policy reimbursed sum of each hospital as the medical expense of the target citiesGold-sprinkled volume.
203, using the target cities medical expense policy reimbursed sum and the target cities in each hospitalMedical expense, calculate the practical reimbursement ratio of the medical expense of the target cities.
Optionally, a kind of method of the practical reimbursement ratio of the possible medical expense for calculating target cities are as follows: by medical insurancePolicy reimbursed sum is the sum of the medical expense of each hospital divided by medical expense summation, expense summation, obtains target citiesThe practical reimbursement ratio of medical expense.
If 204, the difference between the policy reimbursement ratio and the practical reimbursement ratio is higher than preset reimbursement ratioDifference determines the medical insurance policies of the target cities then according to the policy reimbursed sum of the medical expense of the target citiesSimulate regulation method.
Optionally, a kind of scheme of the possible medical insurance policies simulation regulation method for determining target cities includes stepC1-C3, specific as follows:
C1, according to the practical reimbursed sum of the medical expenses of target cities and the medical expense of the target cities, drawThe medical security curve of the target cities；
Optionally, a kind of possible drafting mode of medical security curve includes step C11-C13, specific as follows:
C11, amount of money section is determined；
Optionally, it be 20 according to the amount of money is segment that the determination method in amount of money section, which for example may is that, i.e., 0-20 member is theOne section, 20-40 are second interval, carry out demarcation interval with this, the amount of money upper limit is unlimited.
C12, the reimbursement mean value for obtaining each amount of money section；
Optionally, amount of money number and the amount of money of the medical expense in each section in target cities are obtained, wherein the amount of moneyNumber can be understood as number, and the reimbursement mean value in each amount of money section is sought according to the amount of money number and the amount of money.Wherein, it obtainsThe method of amount of money number in each section can be the medical amount of money that each case is obtained from the system of each hospital, rightThe amount of money extracts in the way of above-mentioned amount of money section, obtains each gold in each amount of money section of each hospitalThe number of volume, and the reimbursed sum of each amount of money is extracted, to seek each hospital in the mean value in each amount of money section.
C13, it draws according to each amount of money section and reimbursement mean value and ensures curve；
Optionally, using horizontal axis as amount of money section, the longitudinal axis is that reimbursement mean value draws guarantee curve.
C2, from the medical security curve of the target cities, determine the risk of the medical insurance policies of the target citiesPoint；
Optionally, judge whether the guarantee curve trip point occurs, if there is trip point, it is determined that the trip point is medical insuranceThe risk point of policy.
C3, according to the risk point of the medical insurance policies, determine the medical insurance policies simulation regulation method of the target cities.
Optionally, a kind of possible risk point according to medical insurance policies determines the medical insurance policies simulation regulation of target citiesMethod includes step C31-C33, specific as follows:
C31, policy reimbursement ratio is extracted in amount of money section where the risk point of the medical insurance policies lower than default reimbursementAt least one target case of proportion threshold value；
Wherein, it due to being made of in amount of money section the policy reimbursed sum of multiple patients, then can be asked by foregoing mannerThe policy of each patient is taken to submit an expense account ratio.Default reimbursement proportion threshold value can be set by medicare system according to different citiesIt is fixed, it can also be set by system manager.Target case can be understood as patient.
The medical insurance drug group of at least one target case described in C32, acquisition and non-medical insurance drug group；
Wherein, the medical insurance drug group of target case can be understood as target case and carry out used drug when disease treatmentIn medical insurance drug set, non-medical insurance drug group can be understood as target case and carries out when disease treatment in used drugNon- medical insurance drug set.
C33, the non-medical insurance drug of presetting in the non-medical insurance drug group of at least one target case is added toThe method of above-mentioned medical insurance drug group simulates regulation method as the medical insurance policies of the target cities.
Optionally, presetting non-medical insurance drug can be medical insurance drug for not insured drug (drug at one's own expense), can specifically selectIt is derived from the medicine at one's own expense that drug is costly in expense medicine, such as drug expenditure is higher than 500 yuan of drug at one's own expense.
Optionally, the policy reimbursed sum of another medical expense according to the target cities, determines the targetThe medical insurance policies in city simulate regulation method are as follows: the policy reimbursed sum of the medical expense of the target cities is input to policyIn simulation engine, the medical insurance policies simulation regulation method of the target cities is obtained.
Wherein, policy simulation engine is obtained after being learnt using machine learning to sample data, wherein machine learning mouldType is supervised learning model, and supervised learning model for example can be weight model etc. in artificial neural network method, and policy is imitativeA kind of method for building up of true engine are as follows: sample is subjected to feature extraction first, obtains feature set, then feature set is inputted and is trainedIn model, training pattern is learnt according to the algorithm in training pattern, which for example can be gradient descent method, newton calculatesMethod, conjugate gradient algorithms etc. finally obtain policy simulation engine, in this approach, by the study to a large amount of sample, finalTo policy simulation engine.By machine learning model, a large amount of sample is learnt, can accurately determine policySimulation engine, to improve the accuracy when medical insurance policies simulation regulation method obtains.Sample data is the policy chosenReimbursed sum and medical insurance policies simulate regulation method.
205, simulation regulation is carried out to the medical insurance policies of the target cities according to medical insurance policies simulation regulation method.
It is carried out in a possible example, then using medical insurance policies of the medical insurance policies simulation regulation method to target citiesIt can also include following method after simulation regulation, referring specifically to step D1-D5:
D1, obtain objective hospital in the target cities target department medical expense, the doctor of the target departmentTreatment expense includes surgery cost, and the surgery cost includes the expense of multiple operation drugs；
Optionally, there are multiple departments, different departments may have different medical expenses, Mei Geke in objective hospitalThe expense composition of medical expense in room may be different.Target department attaches most importance to disease department, such as cancer department, treatment are seriousThe department etc. of burn.Target department may be the department that average medical expense is more than 100,000 yuan or more.Objective hospital can beNeed to carry out the hospital of medical insurance policies adjustment, such as the hospital of risk occurs in the medical policy of the hospital.
D2, calculate the target department medical expense practical reimbursed sum；
Optionally, practical reimbursed sum can be policy reimbursed sum, calculate the practical report of the medical expense of target departmentThe calculation that the method for gold-sprinkled volume can refer to the policy reimbursed sum in step 202 is calculated.
If D3, the target department medical expense practical reimbursed sum be lower than the first default reimbursed sum, obtainTarget medicine, the target medicine are the highest drug of expense in the multiple operation drug；
Optionally, medicare system prestores the mapping relations between department and default reimbursed sum, can pass through above-mentioned mappingRelationship determines the preset reimbursed sum of target department.
D4, the policy reimbursed sum for obtaining the target medicine；
If the policy reimbursed sum of D5, the target medicine is lower than the second default reimbursed sum, by the target medicinePolicy reimbursed sum be adjusted to target reimbursed sum, the policy that the target reimbursed sum is greater than the target medicine submits an expense account goldVolume, the first default reimbursed sum are greater than the described second default reimbursed sum.
By this exemplary method, the policy reimbursed sum of the highest drug of expense in drug of performing the operation is adjusted to higherTarget reimbursed sum is able to ascend medical insurance reimbursement ratio, so as to reduce medical treatment caused by the medical expense of weight disease peopleBurden.
Referring to Fig. 3, Fig. 3 provides the flow diagram of another regulation method for the embodiment of the present application.Such as Fig. 3 instituteTo show, regulation method includes step 301-307, specific as follows:
301, the medical insurance policies of target cities are obtained, and obtain the medical expense of the target cities, the target cityThe medical expense in city includes the medical expense of each hospital in the target cities, and the medical expense includes medical insurance reimbursement ingredientThe amount of money；
302, it extracts the medical insurance in the target cities in the medical expense of each hospital and submits an expense account the ingredient amount of money；
303, the medical insurance reimbursed sum ingredient in the medical expense of each hospital is submitted an expense account into ratio multiplied by the policy,Obtain the policy reimbursed sum of the medical expense of each hospital；
304, the medical treatment by the sum of policy reimbursed sum of medical expense of each hospital as the target citiesThe policy reimbursed sum of expense；
305, using the target cities medical expense policy reimbursed sum and the target cities in each hospitalMedical expense, calculate the practical reimbursement ratio of the medical expense of the target cities；
If 306, the difference between the policy reimbursement ratio and the practical reimbursement ratio is higher than preset reimbursement ratioDifference determines the medical insurance policies of the target cities then according to the policy reimbursed sum of the medical expense of the target citiesSimulate regulation method；
307, simulation regulation is carried out to the medical insurance policies of the target cities according to medical insurance policies simulation regulation method.
In this example, according to the medical insurance reimbursement ingredient amount of money and policy report in the medical expense of hospital each in target citiesThe policy of the medical expense of each hospital optionally, is submitted an expense account gold to calculate the policy reimbursed sum of target cities by pin ratioPolicy reimbursed sum of the sum of the volume as target cities medical expense, more can completely reflect target city to a certain extentThe policy reimbursed sum in city, so as to promote accuracy when Policy Adjustment method determines.
Referring to Fig. 4, Fig. 4 provides the flow diagram of another regulation method for the embodiment of the present application.Such as Fig. 4 instituteTo show, regulation method includes step 401-408, specific as follows:
401, the medical insurance policies of target cities are obtained, and obtain the medical expense of the target cities, the target cityThe medical expense in city includes the medical expense of each hospital in the target cities；
402, the medication collection of each hospital is extracted, the medication collection includes medical insurance drug；
403, the Sales Volumes of the medical insurance drug of each hospital are obtained；
404, the Sales Volumes of the medical insurance drug of each hospital are submitted an expense account into ratio multiplied by the policy, obtained describedThe policy reimbursed sum of each hospital；
405, the policy by the sum of policy reimbursed sum of each hospital as the medical expense of the target citiesReimbursed sum；
406, using the target cities medical expense policy reimbursed sum and the target cities in each hospitalMedical expense, calculate the practical reimbursement ratio of the medical expense of the target cities；
If 407, the difference between the policy reimbursement ratio and the practical reimbursement ratio is higher than preset reimbursement ratioDifference determines the medical insurance policies of the target cities then according to the policy reimbursed sum of the medical expense of the target citiesSimulate regulation method；
408, simulation regulation is carried out to the medical insurance policies of the target cities according to medical insurance policies simulation regulation method.
In this example, the policy reimbursed sum of each hospital is determined by the medication collection of each hospital, it can be moreReally reflect the reimbursed sum of each hospital, is determined so as to promote medical insurance policies simulation regulation method to a certain extentWhen accuracy.
Referring to Fig. 5, Fig. 5 provides the flow diagram of another regulation method for the embodiment of the present application.Such as Fig. 5 instituteTo show, regulation method includes step 501-509, specific as follows:
501, the medical insurance policies of target cities are obtained, and obtain the medical expense of the target cities, the target cityThe medical expense in city includes the medical expense of each hospital in the target cities；
502, the payment for medical care of each hospital in ratio and the target cities is submitted an expense account according to the policy in the medical insurance policiesWith determining the policy reimbursed sum of the medical expense of the target cities；
503, using the target cities medical expense policy reimbursed sum and the target cities in each hospitalMedical expense, calculate the practical reimbursement ratio of the medical expense of the target cities；
If 504, the difference between the policy reimbursement ratio and the practical reimbursement ratio is higher than preset reimbursement ratioDifference, then according to the medical expense of the practical reimbursed sum of the medical expense of target cities and the target cities, described in draftingThe medical security curve of target cities, the medical security curve include multiple amount of money sections；
505, from the medical security curve of the target cities, the risk of the medical insurance policies of the target cities is determinedPoint；
506, policy reimbursement ratio is submitted an expense account lower than default in the amount of money section where the risk point of the extraction medical insurance policiesAt least one target case of proportion threshold value；
507, the medical insurance drug group and non-medical insurance drug group of at least one target case are obtained；
508, the non-medical insurance drug of presetting in the non-medical insurance drug group of at least one target case is added toThe method of above-mentioned medical insurance drug group simulates regulation method as the medical insurance policies of the target cities；
509, simulation regulation is carried out to the medical insurance policies of the target cities according to medical insurance policies simulation regulation method.
In this example, by comparing the difference between policy reimbursement ratio and practical reimbursement ratio, when the difference is greater than in advanceIf reimbursement proportional difference when, to draw the medical security curve of target cities, medical treatment is determined according to medical security curveThen the risk point of policy carries out medical insurance policies by the way that preset non-medical insurance drug is added to the method in medical insurance drug groupRegulation, therefore, by determining risk point from medical security curve, determines risk relative to by artificial modePoint can promote the efficiency of determining risk point to a certain extent, and then can promote medical insurance policies simulation regulation to a certain extentThe efficiency that method generates.
Referring to Fig. 6, Fig. 6 provides the flow diagram of another regulation method for the embodiment of the present application.Such as Fig. 6 instituteTo show, regulation method includes step 601-610, specific as follows:
601, the medical insurance policies of target cities are obtained, and obtain the medical expense of the target cities, the target cityThe medical expense in city includes the medical expense of each hospital in the target cities；
602, the payment for medical care of each hospital in ratio and the target cities is submitted an expense account according to the policy in the medical insurance policiesWith determining the policy reimbursed sum of the medical expense of the target cities；
603, using the target cities medical expense policy reimbursed sum and the target cities in each hospitalMedical expense, calculate the practical reimbursement ratio of the medical expense of the target cities；
If 604, the difference between the policy reimbursement ratio and the practical reimbursement ratio is higher than preset reimbursement ratioDifference determines the medical insurance policies of the target cities then according to the policy reimbursed sum of the medical expense of the target citiesSimulate regulation method；
605, simulation regulation is carried out to the medical insurance policies of the target cities according to medical insurance policies simulation regulation method；
606, the medical expense of the target department of the objective hospital in the target cities, the doctor of the target department are obtainedTreatment expense includes surgery cost, and the surgery cost includes the expense of multiple operation drugs；
607, the practical reimbursed sum of the medical expense of the target department is calculated；
If 608, the practical reimbursed sum of the medical expense of the target department is lower than the first default reimbursed sum, obtainTarget medicine, the target medicine are the highest drug of expense in the multiple operation drug；
609, the policy reimbursed sum of the target medicine is obtained；
If 610, the policy reimbursed sum of the target medicine is lower than the second default reimbursed sum, by the target medicinePolicy reimbursed sum be adjusted to target reimbursed sum, the policy that the target reimbursed sum is greater than the target medicine submits an expense account goldVolume, the first default reimbursed sum are greater than the described second default reimbursed sum.
In this example, simulation regulation is carried out to the medical insurance policies of target cities simulating regulation method by medical insurance policiesAfterwards, the medical expense for obtaining the target department of the objective hospital in target cities again, judges the medical expense of the target departmentPractical reimbursed sum whether reach the first default reimbursed sum, if be lower than the amount of money, extract drug of performing the operation in medical expenseThe highest drug of expense, regulates and controls the reimbursed sum of the drug, with this, in the higher department of medical expense, by upperMode is stated, medical reimbursed sum is regulated and controled, patient can be reduced to a certain extent to the burden in medical expense, so as toPracticability when reimbursement of the medical insurance policies to high medical expense is enough promoted to a certain extent.
It is consistent with above-described embodiment, referring to Fig. 7, Fig. 7 is that a kind of structure of terminal provided by the embodiments of the present application is shownIt is intended to, as shown, including processor, input equipment, output equipment and memory, the processor, input equipment, output are setStandby and memory is connected with each other, wherein for the memory for storing computer program, the computer program includes that program refers toIt enables, the processor is configured for calling described program instruction, and above procedure includes the instruction for executing following steps；
The medical insurance policies of target cities are obtained, and obtain the medical expense of the target cities, the target citiesMedical expense includes the medical expense of each hospital in the target cities；
The medical expense of each hospital in ratio and the target cities is submitted an expense account according to the policy in the medical insurance policies, reallyMake the policy reimbursed sum of the medical expense of the target cities；
Using the doctor of each hospital in the policy reimbursed sum of the medical expense of the target cities and the target citiesTreatment expense calculates the practical reimbursement ratio of the medical expense of the target cities；
If the difference between the policy reimbursement ratio and the practical reimbursement ratio is higher than preset reimbursement proportional difference,Then according to the policy reimbursed sum of the medical expense of the target cities, determine that the medical insurance policies simulation of the target cities is adjustedProsecutor method；
Simulation regulation is carried out to the medical insurance policies of the target cities according to medical insurance policies simulation regulation method.
By the embodiment of the present application, the medical insurance policies of target cities are obtained, and obtain the payment for medical care of the target citiesWith the medical expense of the target cities includes the medical expense of each hospital in the target cities, according to the medical insurance political affairsThe medical expense of each hospital, determines the medical treatment of the target cities in policy reimbursement ratio and the target cities in planThe policy reimbursed sum of expense, using every in the policy reimbursed sum of the medical expense of the target cities and the target citiesThe medical expense of a hospital calculates the practical reimbursement ratio of the medical expense of the target cities, if the policy submits an expense account ratioDifference between example and the practical reimbursement ratio is higher than preset reimbursement proportional difference, then according to the medical treatment of the target citiesThe policy reimbursed sum of expense determines the medical insurance policies simulation regulation method of the target cities, according to the medical insurance policiesSimulation regulation method carries out simulation regulation to the medical insurance policies of the target cities, relies on manually accordingly, with respect to existingMode regulates and controls medical insurance policies, can promote timeliness when regulating and controlling to medical insurance policies and accurate to a certain extentProperty.
It is above-mentioned that mainly the scheme of the embodiment of the present application is described from the angle of method side implementation procedure.It is understood that, in order to realize the above functions, it comprises execute the corresponding hardware configuration of each function and/or software module for terminal.ThisField technical staff should be readily appreciated that, in conjunction with each exemplary unit and algorithm of embodiment description presented hereinStep, the application can be realized with the combining form of hardware or hardware and computer software.Some function actually with hardware alsoIt is the mode of computer software driving hardware to execute, the specific application and design constraint depending on technical solution.ProfessionTechnical staff can specifically realize described function to each using distinct methods, but this realization should not be recognizedFor beyond scope of the present application.
The embodiment of the present application can carry out the division of functional unit according to above method example to terminal, for example, can be rightThe each functional unit of each function division is answered, two or more functions can also be integrated in a processing unit.Above-mentioned integrated unit both can take the form of hardware realization, can also realize in the form of software functional units.It needsIllustrate, is schematical, only a kind of logical function partition to the division of unit in the embodiment of the present application, it is practical to realizeWhen there may be another division manner.
Consistent with the above, referring to Fig. 8, Fig. 8 provides a kind of structural representation of regulation device for the embodiment of the present applicationFigure, described device include acquiring unit 801, the first determination unit 802, computing unit 803, the second determination unit 804 and regulationUnit 805, wherein
Acquiring unit 801, for obtaining the medical insurance policies of target cities, and the payment for medical care of the acquisition target citiesWith the medical expense of the target cities includes the medical expense of each hospital in the target cities；
First determination unit 802, for according in the policy reimbursement ratio and the target cities in the medical insurance policiesThe medical expense of each hospital determines the policy reimbursed sum of the medical expense of the target cities；
Computing unit 803, policy reimbursed sum and the target city for the medical expense using the target citiesThe medical expense of each hospital in city calculates the practical reimbursement ratio of the medical expense of the target cities；
Second determination unit 804, if it is high to submit an expense account the difference between ratio and the practical reimbursement ratio for the policyIn preset reimbursement proportional difference, then according to the policy reimbursed sum of the medical expense of the target cities, the mesh is determinedThe medical insurance policies for marking city simulate regulation method；
Regulate and control unit 805, for the medical insurance policies according to medical insurance policies simulation regulation method to the target citiesCarry out simulation regulation.
In this example, the medical insurance policies of target cities are obtained, and obtain the medical expense of the target cities, the meshThe medical expense in mark city includes the medical expense of each hospital in the target cities, according to the policy in the medical insurance policiesThe medical expense of each hospital, determines the policy of the medical expense of the target cities in reimbursement ratio and the target citiesReimbursed sum, using the doctor of each hospital in the policy reimbursed sum of the medical expense of the target cities and the target citiesTreatment expense calculates the practical reimbursement ratio of the medical expense of the target cities, if policy reimbursement ratio and the realityDifference between border reimbursement ratio is higher than preset reimbursement proportional difference, then according to the policy of the medical expense of the target citiesReimbursed sum determines the medical insurance policies simulation regulation method of the target cities, simulates regulation side according to the medical insurance policiesMethod carries out simulation regulation to the medical insurance policies of the target cities, accordingly, with respect to it is existing by artificial mode to medical insurancePolicy is regulated and controled, and can promote timeliness and accuracy when regulating and controlling to medical insurance policies to a certain extent.
Optionally, the medical expense includes the medical insurance reimbursement ingredient amount of money, in the political affairs according in the medical insurance policiesPlan submits an expense account the medical expense of each hospital in ratio and the target cities, determines the political affairs of the medical expense of the target citiesIn terms of plan reimbursed sum, first determination unit 802 is specifically used for:
Extract the medical insurance reimbursement ingredient amount of money in the target cities in the medical expense of each hospital；
By the medical insurance reimbursed sum ingredient in the medical expense of each hospital multiplied by the reimbursement ratio, obtain describedThe policy reimbursed sum of the medical expense of each hospital；
Medical expense of the sum of the policy reimbursed sum of medical expense by each hospital as the target citiesPolicy reimbursed sum.
Optionally, each hospital in the policy reimbursement ratio according in the medical insurance policies and the target citiesMedical expense, in terms of the policy reimbursed sum for determining the medical expense of the target cities, first determination unit 802Also particularly useful for:
The medication collection of each hospital is extracted, the medication collection includes medical insurance drug；
Obtain the Sales Volumes of the medical insurance drug of each hospital；
The Sales Volumes of the medical insurance drug of each hospital are submitted an expense account into ratio multiplied by the policy, are obtained described eachThe policy reimbursed sum of hospital；
The sum of policy reimbursed sum by each hospital is submitted an expense account as the policy of the medical expense of the target citiesThe amount of money.
Optionally, in the policy reimbursed sum of the medical expense according to the target cities, the target is determinedIn terms of the medical insurance policies simulation regulation method in city, second determination unit 804 is specifically used for:
According to the medical expense of the practical reimbursed sum of the medical expense of target cities and the target cities, described in draftingThe medical security curve of target cities；
From the medical security curve of the target cities, the risk point of the medical insurance policies of the target cities is determined；
According to the risk point of the medical insurance policies, the medical insurance policies simulation regulation method of the target cities is determined.
Optionally, the medical security curve includes multiple amount of money sections, in the risk according to the medical insurance policiesPoint determines the medical insurance policies simulation regulation method aspect of the target cities, and second determination unit 804 is also specific to be usedIn:
It extracts policy reimbursement ratio in the amount of money section where the risk point of the medical insurance policies and is lower than default reimbursement ratioAt least one target case of threshold value；
Obtain the medical insurance drug group and non-medical insurance drug group of at least one target case；
By in the non-medical insurance drug group of at least one target case preset non-medical insurance drug be added to it is above-mentionedThe method of medical insurance drug group simulates regulation method as the medical insurance policies of the target cities.
Optionally, in the policy reimbursed sum of the medical expense according to the target cities, the target is determinedCity medical insurance policies simulation regulation method in terms of, second determination unit 804 also particularly useful for:
The policy reimbursed sum of the medical expense of the target cities is input in policy simulation engine, the mesh is obtainedThe medical insurance policies for marking city simulate regulation method.
Optionally, regulation device also particularly useful for:
Obtain the medical expense of the target department of the objective hospital in the target cities, the payment for medical care of the target departmentWith including surgery cost, the surgery cost includes the expense of multiple operation drugs；
Calculate the practical reimbursed sum of the medical expense of the target department；
If the practical reimbursed sum of the medical expense of the target department is lower than the first default reimbursed sum, target is obtainedDrug, the target medicine are the highest drug of expense in the multiple operation drug；
Obtain the policy reimbursed sum of the target medicine；
If the policy reimbursed sum of the target medicine is lower than the second default reimbursed sum, by the political affairs of the target medicinePlan reimbursed sum is adjusted to target reimbursed sum, and the target reimbursed sum is greater than the policy reimbursed sum of the target medicine,The first default reimbursed sum is greater than the described second default reimbursed sum.
The embodiment of the present application also provides a kind of computer storage medium, wherein computer storage medium storage is for electricityThe computer program of subdata exchange, it is as any in recorded in above method embodiment which execute computerA kind of some or all of regulation method step.
The embodiment of the present application also provides a kind of computer program product, and the computer program product includes storing calculatingThe non-transient computer readable storage medium of machine program, the computer program make computer execute such as above method embodimentSome or all of any regulation method of middle record step.
It should be noted that for the various method embodiments described above, for simple description, therefore, it is stated as a series ofCombination of actions, but those skilled in the art should understand that, the application is not limited by the described action sequence becauseAccording to the application, some steps may be performed in other sequences or simultaneously.Secondly, those skilled in the art should also knowIt knows, the embodiments described in the specification are all preferred embodiments, related actions and modules not necessarily the applicationIt is necessary.
In the above-described embodiments, it all emphasizes particularly on different fields to the description of each embodiment, there is no the portion being described in detail in some embodimentPoint, reference can be made to the related descriptions of other embodiments.
In several embodiments provided herein, it should be understood that disclosed device, it can be by another wayIt realizes.For example, the apparatus embodiments described above are merely exemplary, such as the division of the unit, it is only a kind ofLogical function partition, there may be another division manner in actual implementation, such as multiple units or components can combine or canTo be integrated into another system, or some features can be ignored or not executed.Another point, shown or discussed is mutualCoupling, direct-coupling or communication connection can be through some interfaces, the indirect coupling or communication connection of device or unit,It can be electrical or other forms.
The unit as illustrated by the separation member may or may not be physically separated, aobvious as unitThe component shown may or may not be physical unit, it can and it is in one place, or may be distributed over multipleIn network unit.It can select some or all of unit therein according to the actual needs to realize the mesh of this embodiment scheme's.
It, can also be in addition, applying for that each functional unit in bright each embodiment can integrate in one processing unitIt is that each unit physically exists alone, can also be integrated in one unit with two or more units.Above-mentioned integrated listMember both can take the form of hardware realization, can also be realized in the form of software program module.
If the integrated unit is realized in the form of software program module and sells or use as independent productWhen, it can store in a computer-readable access to memory.Based on this understanding, the technical solution of the application substantially orPerson says that all or part of the part that contributes to existing technology or the technical solution can body in the form of software productsReveal and, which is stored in a memory, including some instructions are used so that a computer equipment(can be personal computer, server or network equipment etc.) executes all or part of each embodiment the method for the applicationStep.And memory above-mentioned includes: USB flash disk, read-only memory (read-only memory, ROM), random access memoryThe various media that can store program code such as (random access memory, RAM), mobile hard disk, magnetic or disk.
Those of ordinary skill in the art will appreciate that all or part of the steps in the various methods of above-described embodiment is canIt is completed with instructing relevant hardware by program, which can store in a computer-readable memory, memoryIt may include: flash disk, read-only memory, random access device, disk or CD etc..
The embodiment of the present application is described in detail above, specific case used herein to the principle of the application andEmbodiment is expounded, the description of the example is only used to help understand the method for the present application and its core ideas；At the same time, for those skilled in the art can in specific embodiments and applications according to the thought of the applicationThere is change place, in conclusion the contents of this specification should not be construed as limiting the present application.