基于数据挖掘的医保控费系统  

Medical Insurance Fee Control System Based on Data Mining

作　　者：刘佩 LIU Pei(Yantai Psychological Rehabilitation Hospital,Yantai 265200,China)

机构地区：[1]烟台市心理康复医院,山东烟台265200

出　　处：《计算机与现代化》2023年第6期89-94,共6页Computer and Modernization

基　　金：山东省优秀中青年科学家科研奖励基金资助项目(BS2018SW427)。

摘　　要：医保控费可以保证国家医保基金的稳定支出,但是医保控费系统的功能和性能无法满足用户的要求,本文设计一种基于数据挖掘的医保控费系统。利用射频发射装置,设计医保费用数据同步器,结合医保费用数据提取电路和医保费用控制器,完成系统的硬件设计;在软件设计中,根据医保费用数据的属性,计算出医保费用信息的增益值,利用数据挖掘算法,提取出医保费用数据的特征,通过对门诊医保费用的分类,设计医保费用控制算法,实现医保费用的控制。测试结果表明,本文系统的医保费用控制功能满足用户的要求,而且可以将违规金额占比和内存占有率分别控制在17%和20%以内,大大提高了系统的性能。Medical insurance fee control can ensure the stable expenditure of national medical insurance fund,but the function and performance of medical insurance fee control system can not meet the requirements of users.This paper designs a medical in⁃surance fee control system based on data mining.Using the RF transmitter,the medical insurance expense data synchronizer is designed.Combined with the medical insurance expense data extraction circuit and medical insurance expense controller,the hardware design of the system is completed.In the software design,according to the attributes of medical insurance expense data,the gain value of medical insurance expense information is calculated,and the characteristics of medical insurance ex⁃pense data are extracted by using data mining algorithm.Through the classification of outpatient medical insurance expenses,the medical insurance expense control algorithm is designed to realize the control of medical insurance expenses.The test results show that the medical insurance expense control function of the system meets the requirements of users,and can control the pro⁃portion of illegal amount and memory occupancy within 17%and 20%respectively,which greatly improves the performance of the system.

关 键 词：数据挖掘 医保费用 费用控制 数据同步 射频发射装置 违规金额 

分 类 号：TP311[自动化与计算机技术—计算机软件与理论]