泰州市医疗保险数据挖掘及服务流程优化

发布时间：2018-03-29 12:30

本文选题：数据挖掘　切入点：基本医疗保险　出处：《江苏科技大学》2015年硕士论文

【摘要】：随着金保工程的实施,社会保险管理系统实现数据规范化管理,覆盖全国、运转高效的社保信息化系统的建设迫在眉睫。本文以泰州市基本医疗保险信息系统为例,分析了医疗保险数据的特征,基本医疗保险数据类型多、数据量庞大、数据的变化性,验证了医疗保险信息数据挖掘的可行性。目前很多医疗保险信息系统只有录入、查询、修改等简单的功能,无法从这些数据中获取有价值的信息。因此,需要利用数据这些海量的信息资源为医疗保险中心监管各医疗单位提供科学的决策支持。具体以泰州市城镇职工医疗保险数据库中的部分数据为基础,分析关联规则数据挖掘算法,结合实际需要运用此数据挖掘算法从参保人收入与医疗保险基金支出、参保人基本信息与常见疾病、分年龄门诊信息三个方面进行数据挖掘。同时,泰州市社会保障服务系统主要包括综合业务管理系统、业务经办系统、自助查询系统三大方面,医疗保险经办系统是其中的主要组成部分之一。本文介绍了医疗保险业务具体流程并对其分类,分析医疗保险服务流程优化的必要性和可行性,设计医疗保险服务流程优化可行的方案,比如参保人员登记管理、社会保险费用征缴、社会保险待遇审核、基金监管以及决策支持,并从医疗保险电子档案构建、社保服务优质化、医疗保险基金管理、医疗保险服务信息网络反馈体系四个方面提出具体措施。最后,基于医疗保险数据挖掘的分析结果以及医疗保险服务流程的研究,为泰州市医疗保险信息系统的构建提供了可行的建议。
[Abstract]:With the implementation of the golden insurance project, the social insurance management system realizes the standardized data management, covers the whole country, and runs the social security information system with high efficiency. This paper takes the Taizhou City basic medical insurance information system as an example. The characteristics of medical insurance data are analyzed. There are many types of basic medical insurance data, the amount of data is huge and the data is variable, which verifies the feasibility of medical insurance information data mining. At present, many medical insurance information systems only input and inquire, Simple functions such as modification can't get valuable information from the data. Therefore, It is necessary to make use of these massive information resources to provide scientific decision support for the medical units supervised by the Medical Insurance Center, which is based on some of the data in the medical insurance database for urban workers in Taizhou. This paper analyzes the association rules data mining algorithm, and applies this data mining algorithm from the insured income and medical insurance fund expenditure, the basic information of the insured and common diseases. At the same time, the social security service system of Taizhou mainly includes three aspects: integrated business management system, business administration system, self-service inquiry system. The medical insurance management system is one of the main components. This paper introduces and classifies the medical insurance business, and analyzes the necessity and feasibility of optimizing the medical insurance service flow. Design the feasible scheme of medical insurance service flow optimization, such as registration management, social insurance fee collection, social insurance treatment audit, fund supervision and decision support, and build from the medical insurance electronic file, Four specific measures are put forward in the aspects of social security service optimization, medical insurance fund management, medical insurance service information network feedback system. Finally, based on the analysis results of medical insurance data mining and the research of medical insurance service flow, It provides feasible suggestions for the construction of Taizhou medical insurance information system.
【学位授予单位】：江苏科技大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R197.1;F842.684

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