JP3999764B2 - Medical expenses information provision system - Google Patents

Description

  The present invention relates to a medical cost burden calculation system and a medical cost burden calculation method for calculating a medical cost burden, which are borne by a patient or a non-patient medical cost bearer.

Conventional technology

  In general, a part of medical expenses charged to a patient may be borne by an insurer or the like. In such a case, the medical expenses are settled, for example, in such a manner that the patient once pays the amount requested from the medical institution and the insurer pays the patient's own burden later.

  On the other hand, in recent years, insurance services based on the conditions of each insured person, such as making a difference in the insurance burden ratio between smokers and non-smokers, have been desired. It is becoming.

  In such a current situation, in order to further promote diversification of insurance services or medical services, a system capable of acquiring necessary information from the respective positions of insured persons, medical institutions, insurers, etc. is necessary. .

  In addition, for example, the waiting time for payment of medical expenses at a medical institution is often long. Furthermore, when changing the partial amount of the medical expenses, it may be necessary to submit various documents such as a doctor's medical certificate, which is not annoying. Improvement of these problems related to medical expenses settlement has long been desired.

The present invention has been made in view of the above circumstances, and can provide effective information related to medical payments to insured persons, medical institutions, insurance companies, etc. quickly and easily, The purpose is to provide a medical cost information providing system that can be improved.

  In order to achieve the above object, the present invention takes the following measures.

According to the first aspect of the present invention, a first computer system provided on a patient side who is a candidate for receiving medical practice is connected to the first computer system via a network. A medical cost information providing system comprising: a second computer system that provides the first computer system with information including a medical cost burden amount or a burden ratio related to an action, wherein the first computer system includes: An input means for inputting specific information for specifying a medical institution and medical action in the medical institution, and when the specific information is input, the specific information is input to the second computer system via the network. A first transmission means for transmitting to the medical computer, wherein the second computer system is an insurance business relating to medical expenses. The storage means for storing the burden information defined by the insurer for each medical institution and the specific information are received, and the storage means is searched and specified by the received specific information. When the patient receives a medical action at a medical institution, the calculation means for simulating various burden ratios or patterns of the amount to be borne by the insurer, and the simulation result when the simulation is executed And a generating means for generating a list for displaying a list in association with a burden ratio or a burden amount of a medical institution and an insurer, and when the list is generated, the list is generated via the network. a second transmission means for providing the presentation to the patient is transmitted to the first computer system, via the network, the serial A first receiving means for receiving a change instruction from an insurer that changes the burden information, and when the change instruction is received, the burden information stored in the storage means is changed based on the change instruction. A medical cost information providing system characterized in that the insurer provides motivational information for guiding a patient to a predetermined medical institution.

  According to such a configuration, it is possible to quickly and easily provide effective information regarding medical payments to an insured person (patient), a medical institution, an insurer, and the like. In addition, it is possible to quickly and easily realize a change in the insurance company, a change in the medical cost burden ratio, and the like. Furthermore, it is possible to reduce the waiting time for the medical expenses settlement at the medical institution.

  As motivation information for insurers to guide patients to a prescribed medical institution, information related to the simulation results, such as the amount of medical expenses that the insurer defines for each medical institution, should be provided before receiving medical care for the patient. it can.

  Each embodiment of a medical cost burden calculation system according to the present invention will be described with reference to the drawings. The important point of this system is that the burden of the bearer who bears a part of the medical expenses for the medical treatment given to a predetermined patient and the burden of the burden of the patient himself can be quickly and The idea is to easily calculate and provide information on the amount of the burden quickly and easily to the parties involved in the settlement of medical expenses. Further, according to the present system, quick and simplified medical cost settlement is possible based on the calculated burden amounts. In the following, each embodiment will be described with a focus on a medical cost burden calculation process, provision of information regarding the burden amount, and a medical cost settlement process based on the calculated burden amount. In the following description, components having substantially the same function and configuration are denoted by the same reference numerals, and redundant description will be given only when necessary.

(First embodiment)
First, the configuration of the medical cost burden calculation system according to the first embodiment will be described with reference to FIG.

  FIG. 1 shows a schematic configuration diagram of a medical cost burden calculation system 1 according to the first embodiment.

  As shown in FIG. 1, a medical cost burden calculation system 1 includes a first system 3 deployed on a computer network of a medical institution and a second system 5 deployed on a computer network of a burden calculation company. And a third system that is a network system such as a LAN, a WAN, and the Internet that connects the first system 3 and the second system 5. Hereinafter, each of the first, second, and third systems will be described.

(First system)
The first system 3 is a system that is deployed on a computer network of a medical institution. The first system 3 includes, for example, a patient information input device 30, a medical cost database 31, and a medical cost management server 32.

  The patient information input device 30 is an input device for inputting information about a patient, such as information that can uniquely identify a patient. For example, in this embodiment, a reading device 300 that reads data from a portable electronic storage medium 301 in which a patient ID is stored and transfers the data to the medical cost management server 32 is employed. However, the present invention is not limited to this, and a configuration in which manual input is performed using, for example, a keyboard or a mouse may be used. For example, an IC card or a magnetic card can be used as the portable electronic storage medium. The portable electronic storage medium stores information about the patient such as the patient name and the date of birth of the patient, in addition to the patient ID for uniquely identifying the patient.

  The medical cost database 31 stores, for each patient, the medical practice performed, the cost required for it, information on the date on which the medical practice was performed, and the like (hereinafter referred to as “patient information”).

  The medical cost management server 32 includes patient information of each patient read by the reading device 300, medical billing information for each patient stored in the medical cost database 31, and other patients as necessary. The insurance information and the like that are present are provided to a server or a terminal of another system described later via the third system.

(Second system)
The second system 5 is a system that is deployed on a computer network of a burden calculating company. The second system 5 includes a burden calculation information database 50, a medical institution information database 51, a settlement performance information database 52, and a medical cost calculation server 53.

  The burden calculation information database 50 is based on various calculation information set in advance, and bearers who bear at least a part of the medical expenses for the medical treatment received by the patient (in each case, each bearer ) Etc., and the burden amount, burden amount, etc. are calculated. In addition, the person who bears the medical expenses refers to a person (natural person or corporation) or a group that bears a part or all of the medical expenses received by the patient instead of the patient himself / herself. Specifically, a hospital, an insurance company, a national or local government, etc. that actually performed medical treatment on a patient can be considered.

  2A, 2B, 2C, and 2D are diagrams schematically illustrating examples of calculation information stored in the burden calculation information database 50, respectively. FIG. 2A shows an example of hospital burden information indicating which medical institution (for example, a hospital) bears what medical action and how much. FIG. 2B shows an example of insurance burden information indicating which insurer bears what medical practice and how much. FIG. 2C shows an example of detailed information regarding each patient. FIG. 2D shows an example of detailed information regarding each bearer.

  The medical institution information database 51 stores the type of payment method for each medical institution and its detailed information.

  FIG. 3 shows an example of medical institution information stored in the medical institution information database 51. As shown in FIG. 3, information such as the type of payment method and the handling financial institution is stored as medical institution information for each medical institution.

  The settlement record information database 52 stores settlement record information managed by, for example, an ID assigned for each reception. The settlement result information includes reception information (reception ID), payment information to a medical institution (for example, payment amount, payment state, payment date, etc.), billing information to a medical cost bearer (billing destination, billing amount, billing) Status, receipt status, etc.).

  4A, 4B, and 4C show examples of medical institution information stored in the settlement result information database 52. FIG. FIG. 4A shows an example of settlement result information arranged so that the patient, the examination items received by the patient, the fee thereof, and the like can be understood for each reception. FIG. 4B shows an example of settlement result information in which medical expenses paid to a medical institution that has been provisionally settled by the calculator are arranged for each reception. FIG. 4C shows an example of settlement result information in which a billing destination and a payment status for each inspection are arranged for each reception.

  The medical cost calculation server 53 manages a medical cost burden calculation system and has, for example, the following configuration.

  FIG. 5 is a diagram showing a schematic configuration of the medical cost calculation server 53.

  As shown in FIG. 5, the medical cost calculation server 53 includes a CPU 530, a medical cost request receiving unit 531, a medical cost calculation unit 532, a medical cost payment unit 533, a burden calculation unit 534, and a medical cost requesting unit 535. ing.

  The CPU 530 is a control unit that controls the entire medical cost calculation server.

  The medical cost request receiving means 531 receives a medical cost payment request from a medical institution. In other words, the medical bill request accepting means 531 receives information for uniquely identifying a patient from the medical bill management server 32 on the computer network of the medical institution and information related to the medical bill for the patient (hereinafter, referred to as the medical bill request). "Medical billing information"). In addition, when insurance is applied to the payment of medical expenses, the medical expenses request receiving means 531 also receives insurance information and the like that the patient has joined from the medical expenses management server 32.

  The medical cost calculation means 532 calculates an amount to be paid to the medical institution by a predetermined calculation in response to a request for medical expenses from the medical institution to the medical cost calculation company.

  In addition, it is not always necessary to request the medical expenses from the medical institution to the medical cost calculating company with an amount actually paid to the medical institution. For example, it may be performed by an amount obtained by multiplying the amount of money paid from the medical cost calculation company to the medical institution by a certain constant, or by a certain number of points determined by a certain conversion method. In other words, any method may be used as long as there is a correspondence that can specify the amount actually paid to the medical institution.

  FIG. 6 is a diagram for explaining an example of a payment burden calculation process executed in the medical cost calculation means 532.

  As shown in the upper part of FIG. 6, the billing cost from the medical institution (2000 yen) and the medical expenses paid to the medical institution (2000 yen) are simply matched, or the points billed by the medical institution (for example, 200 Point) and medical expenses paid to a medical institution (2000 yen). The content of the calculation process executed by the medical cost calculation means 532 may be determined in advance between the medical institution and the burden calculation company.

  The medical cost payment means 533 performs provisional settlement according to the calculated fee to the medical institution. For example, an instruction for transferring each medical cost calculated by the medical cost calculation means 532 to each medical institution is transmitted to a financial institution or the like using a communication line.

  The burden calculation means 534 calculates the medical expenses to be charged to each payer from the information on the medical practice and medical expenses received from the medical institution and the information (see FIGS. 2A to 2D) in the burden calculation information database 50. To do. In other words, the burden calculation means 534 determines whether each burden person and the patient have the medical expenses paid to the medical institution calculated by the medical expenses calculation means 532 and various information stored in the burden calculation information database 50. Calculate the amount of each burden.

  For example, when each burden amount is calculated based on the contents shown in FIGS. 2A to 2D, the burden amount calculation unit 534 executes a medical cost calculation process as follows.

  7A and 7B are diagrams for explaining the medical cost calculation processing executed by the burden calculation means 534. FIG.

  For example, it is assumed that a predetermined patient (patient ID: P0001) who is an insured person of α insurance receives an endoscopic operation in hospital A.

  According to FIG. 2A, when hospital A performs an endoscopic operation, the hospital is registered to bear 1% of the medical expenses incurred. In addition, according to FIG. 2B, the α insurance is registered as bearing 88% of the medical expenses incurred for the endoscopic operation in hospital A. In accordance with these registered contents, the burden calculation means 534 calculates the burden ratio of the medical expenses for the medical action received by the patient.

  FIG. 7B is a diagram showing calculation information obtained by the processing. As shown in FIG. 7B, the burden ratio of the predetermined patient (patient ID: P0001) calculated according to the above contents is 11% of the generated medical expenses reflecting the contents of FIGS. 2A and 2B. Each burden amount calculated by multiplying each burden ratio shown in the figure by the medical expenses is charged to each burden person by the medical expenses requesting means 535 as described later. This content is recorded in the settlement result information database 52.

  Note that the calculation information illustrated in FIG. 7B is in a form summarized for each patient. This form is convenient when the patient is charged for the burden. However, for example, in the case of charging a burden to an insurance company or a hospital, the calculation information regarding all patients is presented, which is not convenient.

  Considering this point, the burden calculation means 534 can create calculation information such as a burden ratio in various forms.

  FIG. 7A shows an example of calculation information in a form compiled for each predetermined bearer (burdener ID: 0001). By presenting the calculation information, for example, an insurer can quickly and easily know the total amount of burden to be borne by all insured persons. This content is recorded in the settlement result information database 52 in a linked manner with the calculation information shown in FIG. 7B. Therefore, for example, the calculation information in FIG. 7B can be called at an arbitrary timing by a predetermined operation such as clicking the column of the patient ID “P0001” in FIG. 7A.

  The medical cost claiming unit 535 bills each payer for medical costs. Specifically, the medical expense billing unit 535 instructs a predetermined financial institution to withdraw from a bank account registered in advance. In addition to this example, for example, a bill may be mailed and a transfer to a designated bank account may be requested, or medical expenses may be billed to another electronic payment system or the like.

(Third system)
The third system is a network system composed of communication lines such as LAN, WAN, Internet, intranet wireless, or wired communication. The first system and the second system are connected via the third system.

(Medical cost burden calculation and settlement)
Next, a burden calculation process and a settlement process realized by the medical cost burden calculation system 1 will be described. Each process realized by the medical cost burden calculation system 1 is executed by a calculation company using a communication line. The medical fee charged by the medical institution is temporarily settled by the calculation company. On the other hand, the calculation company charges the burden to the burdener and charges the patient the remaining amount obtained by subtracting the burden from the medical cost, thereby executing the medical cost settlement.

  Hereinafter, the flow of processing of this system will be described with reference to FIG. 9, taking as an example the case where a medical institution charges a medical fee to a medical recipient.

  FIG. 9 is a diagram illustrating a flow of a burden calculation process and a settlement process realized by the system 1.

  In FIG. 9, first, the patient ID is obtained in the reading device 300 (1). For example, a medical recipient who has been billed for medical expenses at a hospital accounting window will be notified that the medical recipient will use the medical expenses calculation system to pay for the medical expenses. Then, the portable electronic storage medium 301 is presented. A hospital accountant can obtain information for uniquely identifying a patient by inserting the portable electronic storage medium 301 into the reading device 300. Information for specifying the patient is transmitted to the medical cost management server 32.

  Note that it is not necessary to use the portable electronic storage medium 301 as long as the medical expense management server can take in information that uniquely identifies a patient. For example, a configuration in which an ID for simply specifying a patient is simply received and the person in charge inputs the ID to the medical expenses management server 32 using an input device such as a keyboard or a barcode reader can also serve the purpose.

  Next, the medical cost management server 32 associates the ID for uniquely identifying the input patient with the medical cost information stored in the medical cost database 31 and calculates the computer network of the calculator as the medical cost request information. It transmits to the medical cost calculation server 53 on the system 5 (2).

  FIG. 8 shows an example of a screen displayed on the monitor on the medical expense management server 32 side when the medical expense request information is transmitted from the medical expense management server 32 to the medical expense calculation server 53.

  As shown in FIG. 8, on this screen, at least an ID (H0001) for uniquely identifying a medical institution that charges a medical fee, an ID (P0001) for uniquely identifying a patient, a charge amount, and a breakdown of charges are displayed. Has been. When the operator clicks the request button with the mouse, the contents displayed on the screen are transmitted to the medical cost calculation server as medical cost request information.

  By transmitting this medical cost billing information, the medical institution has requested the provisional settlement of the medical cost from the calculator. In addition, by receiving the information, the calculation company shall make a request for provisional settlement from the medical institution and make specific details such as the recipient of the medical practice, the medical practice performed, and the medical expenses incurred. It becomes.

  Note that the content shown in FIG. 8 is not necessarily displayed on the screen. For example, the screen display may be omitted, and the content illustrated in FIG. 8 may be automatically transmitted to the medical cost calculation server in response to reading of the patient ID.

  The characteristic point here is that, from the viewpoint of the patient, the payment of the medical expenses to the hospital is completed at this point. That is, the patient can complete the payment of the medical expenses to the hospital only by having the reading device 300 read his / her storage medium 301. Therefore, the conventional problem of waiting for a long time to pay medical expenses can be solved by this system.

  The medical cost calculation server 53 receives the medical cost request information from the medical cost management server 32 by the medical cost request receiving means 531 (see FIG. 5). Thereafter, the medical cost calculation server 53 calculates the medical cost paid by the calculation company for the request from the medical institution in the medical cost calculation means 532 (see FIG. 6) (3).

  The information received by the medical bill request receiving means 531 is given a reception ID, and is registered as reception information in the settlement record information database 52 as reception information. The medical expenses calculated by the burden calculation means 532 are registered in the settlement result information database 52 as payment information to the medical institution. Note that the details of the processing performed by the medical bill request acceptance unit 531 and the burden calculation unit 532 have been described above, and are omitted here.

  When the steps up to (3) in FIG. 9 have been completed, various information as shown in FIG. 10 is stored in the database 52, for example.

  Subsequently, the medical cost calculation server 53 acquires the payment method type and payment method detailed information for each payee from the medical institution information database 51, and based on the payment method detailed information and the like, The payment means 533 makes provisional payment for medical expenses (4).

  When the provisional settlement process is completed, the payment status and payment date of the payment information to the medical institution in the medical cost settlement performance information database 52 are updated. FIG. 11 shows an example of payment information to the medical institution in the medical expense settlement result information database 52 that is updated when the payment process is completed. In the payment information to the medical institution shown in FIG. 11, new information is added to the payment state and the payment date as compared with the payment information to the medical institution shown in FIG. 10B.

  Subsequently, the medical cost calculation server 53 acquires the calculation information data shown in FIG. 2 from the calculation information database 50 for the calculation information of the patient (5).

  At this time, in the burden ratio information shown in FIGS. 2A, 2B, etc., only a part of necessary information may be extracted, or all the burden ratio information related to the patient may be extracted. For example, when the burden ratio is determined for each examination and a burden request for endoscopic surgery is received from a medical institution, the burden items in FIGS. 2A and 2B correspond to the burden corresponding to the endoscopic surgery. Only percentage information may be acquired. Moreover, you may acquire all the burden ratio information of the said patient irrespective of a burden item.

  The burden calculation means 534 in the medical cost calculation server 53 charges to which burden the medical cost from the burdened person information obtained from the calculation information database 50 and the medical cost claim received from the medical cost management server 32. It is calculated (6).

  The calculated information is registered in the billing information of the medical cost settlement result information database 52. FIG. 12 shows an example of billing information in the medical expenses settlement result information database 52 that is updated when the calculation process is completed. In the billing information shown in FIG. 12, new information is added to the billing destination and the billing amount as compared with the billing information shown in FIG. 10C.

  Subsequently, the medical cost calculation server 53 requests a burden amount from each bearer by the medical cost billing means 535 based on the calculated billing information (7).

  When payment of the burden amount from each bearer is completed in response to the request for the burden amount, a series of medical cost settlement by this system is completed.

  In this embodiment, the steps (3) and (4) related to payment to the medical institution are performed before the steps (5) to (7) related to the billing from the medical cost calculation server to the medical cost bearer. However, these contexts may be interchanged. That is, the steps regarding payment to the medical institution (3) and (4) may be executed between any of the steps (5) to (7).

  Moreover, in the said embodiment, the example which a calculation supplier also performs temporary payment was given. In addition to this, for example, a provisional settlement contractor may be provided separately, and the calculation of the burden and the provisional settlement may be performed by different entities.

  According to the configuration described above, the following effects can be expected.

  First, patients, hospitals, insurance companies, etc. can complete the settlement of medical expenses, which are generally said to be troublesome, by paying only the burden calculated by the calculation company. In particular, the patient can finish the settlement process at the medical institution simply by passing the portable electronic storage medium 301 through the reading device 300. Therefore, it is possible to quickly pay the medical expenses without waiting for a long time.

  Secondly, by simulating various medical cost burden patterns through the above-mentioned burden calculation processing, the insurer or the like can perform monetary motivation on the medical consultation trend of the patient. For example, assume that an insurer wants to guide a patient to hospital A. In this case, as shown in FIG. 2B, if the insurer's burden ratio for the medical action (endoscopic surgery) in the hospital A is increased, the medical cost burden on the patient is reduced. Therefore, the insurer compares the model when receiving medical practice at Hospital A with the model when receiving medical practice at Hospital B, etc., and shows A to the insured (patient). Can motivate going to the hospital. In addition, if a simulation for each insurer is performed, it is possible to provide monetary motivation for insurance participation.

  Third, by simulating various medical cost burden patterns through the above-described burden calculation processing, the medical institution can also perform monetary motivation with respect to a patient's medical examination trend. For example, if the hospital bears a part of the medical expenses for the characteristic treatment of its own hospital, substantial discounts are possible. As a settlement method in this case, for example, a hospital may make a provisional settlement in the same manner as in the case where no medical expenses are borne, and may be charged separately by a calculation trader (settlement trader). For the patient, a part of the medical expenses is borne by the hospital, and medical care can be received at a lower cost. Therefore, it is possible to guide the patient financially in the medical service.

(Second Embodiment)
Next, a second embodiment of the medical cost burden calculation system according to the present invention will be described. The medical cost burden calculation system according to the second embodiment discloses a system in which a medical cost bearer can change his / her burden ratio. The burden ratio can be changed by the burdener at an arbitrary timing.

  First, the configuration of the medical expense burden calculation system according to the second embodiment will be described with reference to FIG.

  FIG. 13: shows the schematic block diagram of the medical expenses burden calculation system 6 which concerns on 2nd Embodiment.

  When comparing the medical cost burden calculation system 6 shown in FIG. 13 with the medical cost burden calculation system 1 shown in FIG. 1, there are two major differences. The first point is that the medical cost calculation server 53 in the medical cost burden calculation system 6 has a function of accepting a change in the content in the burden calculation information database 50. The second point is that the medical cost burden calculation system 6 can communicate with at least the second system via the third system and is a computer network system (hereinafter referred to as “fourth system”). "). Only new components will be described below to avoid duplication.

(Fourth system)
The fourth system 7 is a system that is deployed on the computer network of the medical cost bearer. The fourth system 7 includes, for example, a burdener side terminal 70. The burdener side terminal 70 can display information on the medical cost burden ratio in the database 50. Moreover, the burdener side terminal 70 can transmit the changed information to the server 53 via a network. The medical cost burden ratio changing process executed using these functions will be described in detail later.

(Medical cost calculation server)
As described above, the medical cost calculation server 53 has a function of accepting a change in the content in the burden calculation information database 50. The configuration of the medical cost calculation server 53 is, for example, as shown in FIG.

  FIG. 14 shows a schematic configuration of the medical cost calculation server 53. In the medical cost calculation server 53 shown in the figure, a calculation information changing unit 536 is further added to the configuration of the medical cost calculation server 53 shown in FIG.

  The calculation information changing means 536 receives a change request for the burden calculation information database 50 and actually changes (or updates) the information in the medical calculation information database 50. Specifically, based on direct input from the medical cost calculation server 53 or an instruction from the bearer side terminal 70 of the cost bearer accessed to the medical cost calculation server 53 via the third system. Based on the information, the information in the database 50 is changed.

(Change of burden calculation information)
Next, the change of the burden calculation information in the database 50, which is the subject of the present embodiment, will be described with reference to FIG. The following is an example of a case where a burdener changes the burden ratio of a specific medical practice by the medical cost burden calculation system 6. Note that the calculation company also serves as a temporary settlement of medical expenses and the provisional settlement method is as described in the first embodiment.

  FIG. 17 is a diagram showing a flow of processing when a certain medical cost bearer changes the burden ratio of a specific patient by the medical cost burden calculation system 6.

  In FIG. 17, first, the burdener side terminal 70 requests specific burden amount calculation information data from the medical cost calculation server 53 (1). At this time, from the viewpoint of security, in order to confirm that the subject to be changed is the bearer, access right confirmation by password input or the like is executed. When the access right is confirmed, for example, the contents shown in FIG. 15 are displayed on the display means of the burdener side terminal 70.

  FIG. 15 shows an example of a screen displayed on the display means of the burdener side terminal 70 when requesting the burden amount calculation information data.

  In FIG. 15, when the circle mark on the left side of the search key name is clicked with the mouse, the key is selected as a key used for the search, and the condition can be input in the condition input field. In this state, the operator inputs a search condition in the search key condition input field and clicks the search button at the lower right of the screen with the mouse, whereby a search request is transmitted to the medical cost calculation server 50.

  In this case, only the patient ID is selected as the search key. Therefore, an acquisition request for burden calculation information that matches the input condition (in this case, the patient ID is P0001) is transmitted to the medical cost calculation server 53 using the patient ID as a search key. When a plurality of search keys are checked, information narrowed down by the plurality of search keys is searched.

  The calculation information changing means 536 of the medical cost calculation server 53 receives the acquisition request from the burdener side terminal 70, acquires the burden amount calculation information from the calculation information database 50 according to the search condition, and transmits it to the settlement terminal 70 ( 2).

  Subsequently, the burdener side terminal 70 receives the burden amount calculation information from the calculation information changing unit 536 of the medical cost calculation server, and displays the burden amount calculation information according to the search condition. The burden person changes the content of the displayed burden amount calculation information, for example, as follows.

  FIG. 16 shows the amount of burden calculation information displayed by the burdener side terminal 70 in changing the burden ratio.

  First, the burdener side terminal 70 displays the burden amount calculation information on the screen as shown in FIG. This screen has both the calculation information display and change request functions. When a column desired to be changed on the screen is selected by a predetermined operation, the cursor focuses on the column. By inputting a new condition in this state, the burden calculation information can be changed. Also, if an add button at the lower left of the screen is pressed, a new burden condition can be registered under the item selected at that time.

  After the above change operation, by pressing the transmission button at the lower right of the screen, the burden calculation information displayed on the screen is transmitted to the medical cost calculation server 53, so that the burden calculation information in the calculation information database 50 is stored. A change is requested to the medical cost calculation server 53 (3).

  The calculation information changing means 536 of the medical cost calculation server 53 receives the burden amount calculation information transmitted from the bearer side terminal 70 and reflects the content in the calculation information database 50 (4).

  After the burden amount calculation information changing process described above, the medical cost burden amount calculating process and the settlement process with the changed contents are executed.

  According to such a configuration, the bearer can quickly know the patient's burden calculation information at an arbitrary time. In addition, the burdener can quickly change the current burden amount calculation information at an arbitrary time.

  In this way, if the burden amount can be changed quickly and easily, the burden ratio changing process is not troublesome. Therefore, it is possible to enrich the service variations by reflecting various conditions in the burden ratio. The specific contents will be clarified in the third and subsequent forms described below.

(Third embodiment)
Next, a third embodiment of the medical cost burden calculation system according to the present invention will be described. In the third embodiment, a system in which a medical cost bearer can reflect the health management circumstances of each patient in the medical cost burden is disclosed.

  First, the configuration of the medical cost burden calculation system according to the third embodiment will be described with reference to FIG.

  FIG. 18 shows a schematic configuration diagram of a medical cost burden calculation system 9 according to the third embodiment.

  When the medical cost burden calculation system 9 shown in FIG. 18 and the medical cost burden calculation system 6 shown in FIG. 13 are compared, the following three points are greatly different. The first point is that a health information database 54 (hereinafter referred to as an information database 54) that stores history information related to personal health management is provided on the second system. The second point is that the medical cost calculation server 53 in the medical cost burden calculation system 6 has a function of updating the contents in the information database 54. The third point is that the medical cost burden calculation system 6 is an arbitrary computer network system (hereinafter referred to as “fifth system”) that can communicate with at least the second system via the third system. ). Only new components will be described below to avoid duplication.

(Medical cost calculation server)
As described above, the medical cost calculation server 53 has a function of accepting a change in the contents in the information database 54. The configuration of the medical cost calculation server 53 is, for example, as shown in FIG.

  FIG. 19 shows a schematic configuration of the medical cost calculation server 53 according to the third embodiment. In the medical cost calculation server 53 shown in the figure, health information registration means 537 (hereinafter, history registration means 537) is further added to the configuration of the medical cost calculation server 53 shown in FIG.

  The history registration unit 537 accepts an update request by direct input from the medical cost calculation server 53 or input from a terminal on the fifth system accessed to the medical cost calculation server 53 via the third system. Then, the contents of the health information database 54 are updated.

(History information database)
The information database 54 stores personal health management history (for example, medical checkup history, sports center activity history, etc.) for each patient as health information. In addition, the information database 54 stores a correspondence table in which various types of health management are associated with a predetermined medical cost burden ratio for each burdener (see FIG. 23). In calculating the medical expenses burden, it is determined whether or not the medical expenses should be paid based on the contents of various health care described in the health information. Calculation of the cost burden is executed. This will be described in detail later.

  FIG. 20 shows an example of health information stored in the information database 54. In the figure, from the viewpoint of improving the efficiency of information management, the personal ID in the figure is associated with the above-described patient ID.

  In the present embodiment, the information database 54 is configured in the second system. However, the information database 54 may be provided anywhere as long as the history information registration unit 537 is accessible via the network.

(Fifth system)
The fifth system 8 is a system deployed on an arbitrary computer network. The fifth system 8 has a health information registration terminal 80 (hereinafter, health manager side terminal 80). The health manager side terminal 80 is a terminal that can access the second system via the third system. As a specific example of the fifth system, a system comprising a health manager side terminal 80 provided in a sports center and the Internet, or a system comprising a health manager side terminal 80 in an individual's home and the Internet is considered. It is done.

  The health manager side terminal 80 is, for example, a computer in which a program for registering health information is installed. It is preferable that the program for registering health information can be downloaded through the Internet or the like. The health manager side terminal 80 has a function of registering health information in the information database 54 of the second system. With this function, for example, the patient himself / herself can register the health diagnosis information received at the company in the information database 54 from the health manager side terminal 80 at home. Alternatively, the sports instructor in charge of the patient can register the activity history at the sports center in the health information database at the responsibility of the sports center. It is also possible for the insurer to enter the fact of whether or not the insured is a smoker.

(Registration of health information)
Next, registration of health information in the information database 54, which is the subject of the present embodiment, will be described with reference to FIG. The following is an example in which new health information is registered in the information database 54 by the medical cost burden calculation system 9 from an arbitrary terminal 80 on the fifth system.

  FIG. 21 is a diagram showing a flow of processing when new health information is registered in the information database 54 from the arbitrary terminal 80 by the medical cost burden calculation system 9.

  In FIG. 21, first, the computer on the fifth system downloads a computer program for changing the information database 54 from the calculation server 53 of the calculation company, and starts it. As a result, the computer functions as the health manager side terminal 80 (1).

  In this case, the computer program is downloaded from the medical cost calculation server of the calculator, but the computer program may be downloaded from another server.

  Subsequently, when the program is activated in the health manager side terminal 80, user authentication is performed. This user authentication is performed by, for example, a user name and password input request. The health manager side terminal 80 transmits the input user information to the medical cost calculation server 53 (2).

  Subsequently, the medical cost calculation server 53 acquires past health information related to the user from the information database 54 based on the user authentication information received from the health manager side terminal 80, and sends it to the health manager side terminal 80. Transmit (3).

  Subsequently, in the health manager side terminal 80, the health manager inputs new information on the health information, and requests the medical cost calculation server 53 to register the new information (4). The display of past health information, the input of new information, and the like are executed, for example, in the following manner.

  FIG. 22A shows an example of a screen displaying the health information currently registered in the information database 54 and the new health information input field displayed on the health manager side terminal 80.

  As shown in FIG. 22A, past health information transmitted from the medical cost calculation server 53 is displayed at the top of the screen. On the same screen, by clicking the add button at the lower left, a new input field for health information is displayed at the bottom. For example, the operator. When and what kind of health management activity was performed can be input as new health information. The newly input health information is transmitted to the medical cost calculation server by pressing the transmission button at the lower right of the screen.

  The registration means 537 in the medical cost calculation server 53 receives the health information transmitted from the health manager side terminal 80 and registers it in the information database 54.

(Medical cost burden calculation and settlement)
FIG. 23A shows an example of a correspondence table stored in the information database 54 and corresponding to various health cares and preset burden ratios of each bearer.

  Hereinafter, the medical cost burden calculation process reflecting the health management information will be described with reference to FIGS. 23A and 9. The processes in FIGS. 9A to 9 are the same as those in the first embodiment, and will be described from step (5) in order to avoid duplication.

  After the provisional settlement in step (4), the medical cost calculation server 53 receives the calculation information of the patient from the calculation information database 50, the health information of the patient from the information database 54, and the correspondence table of the corresponding burdenee. (5).

  At this time, in each information shown in FIGS. 2A, 2B, FIG. 23, etc., only a part of necessary information may be extracted, or all burden ratio information related to the patient may be extracted.

  The medical cost calculation server 53 calculates the burden amount to which payer should be charged based on the information on the bearer obtained from the calculation information database 50 and the medical cost claim received from the medical cost management server 32. Calculated by means 534 (6).

  FIG. 23B is a diagram for explaining medical cost burden calculation reflecting health management information. Like FIG. 7B, a predetermined patient who is an insured person of α insurance performs endoscopic surgery at A hospital. The burden ratio data when received is shown. When FIG. 23B and FIG. 7B are compared, the burden ratio of α insurance is 1% higher. This is because the health management information in which the predetermined patient is a non-smoker is reflected in the medical cost burden calculation process based on the correspondence table shown in FIG. 23A.

  In this case, since the burden items of the α insurance are complex, it is preferable that the contents of the items can be displayed. For example, it is preferable that a list of burden contents shown in FIG. 23C is displayed by clicking the α insurance column in the personal burden ratio data shown in FIG. 23B on a predetermined terminal or the like. The calculated information is registered in the billing information in the medical cost settlement result information database 52.

  Subsequently, the medical cost calculation server 53 requests a burden amount from each bearer by the medical cost billing means 535 based on the calculated billing information (7).

  When payment of the burden amount from each bearer is completed in response to the request for the burden amount, a series of medical cost settlement by this system is completed.

  According to the configuration described above, the following effects can be expected.

  The health management of the insured can be easily and quickly reflected in the insurance system. From the bearer (for example, the insurer), the insurance plan can be enriched and the service can be enhanced. Therefore, the insured person (patient) can be guided financially. Further, the bearer can quickly and easily refer to information on the health management of the insured person. The above-mentioned health management history information can be referred to at any timing. For example, when a medical burden bearer updates the burden calculation information by the method described above, the health information of the patient is displayed. By doing so, it is possible to obtain burden calculation information reflecting the individual patient's health management efforts.

  FIG. 22B shows an example of a screen display in which health information is added to the content shown in FIG. According to the screen display shown in the figure, the medical cost bearer can change the burden ratio with reference to the health information displayed at the same time.

  The change of the burden ratio with reference to health information may be configured such that the apparatus is automatically executed regardless of human work. Automatic change by this apparatus can be realized by a configuration in which the history information registration unit 537 of the medical expense calculation server 53 automatically determines from the predesignated condition and health information and changes the calculation information database 50. . Specifically, the history information registration unit 537 may be configured to automatically update the contents of the calculation information database 50 based on whether or not a medical checkup has been received within one year.

  In this system, information related to health management is input from a terminal installed in a sports center or the like and automatically registered in the information database 54. Therefore, it is possible to quickly and easily create information that is particularly effective for the burdener with little human labor.

  In addition, the insured can select a desired one that suits him / her from various health plans set by each insurer.

(Fourth embodiment)
Next, a fourth embodiment of the medical cost burden calculation system according to the present invention will be described. In the medical cost burden calculation system according to the fourth embodiment, a burdener discloses a system that can reflect the medical consultation situation of each patient in the medical cost burden ratio.

  First, the configuration of the medical cost burden calculation system according to the fourth embodiment will be described with reference to FIG.

  FIG. 24 shows a schematic configuration diagram of the medical cost burden calculation system 10 according to the fourth embodiment.

  When comparing the medical cost burden calculation system 10 shown in FIG. 24 with the medical cost burden calculation system 6 shown in FIG. 13, there are two major differences. The first point is that a consultation history information database 55 is provided on the second system for storing history information related to individual medical consultations. The second point is that the medical cost calculation server 53 in the medical cost burden calculation system 6 has a function of accepting registration of contents in the consultation history information database 55. Only new components will be described below to avoid duplication.

(Visit history information database)
The consultation history information database 55 stores a correspondence table (FIG. 25B) in which a consultation history (FIG. 25A) at an individual medical institution and a consultation history for each burdener and a medical expense burden ratio set in advance are associated with each other. . When calculating the amount of medical expenses, it is determined whether or not to pay medical expenses based on the facts of the medical examination recorded in the medical history information, and if insurance is applied, the medical expenses according to the correspondence table are determined. The burden amount is calculated. This will be described in detail later.

  FIG. 25A shows an example of history information (hereinafter referred to as “medical consultation history information”) related to an individual medical consultation stored in the consultation history information database 55. In the medical checkup history information, a medical checkup history corresponding to each request received by the medical bill request receiving means 531, for example, the type of examination received and the type of treatment received, is automatically registered. In the figure, as in FIG. 20, the individual IDs in the figure and the above-described patient IDs are associated with each other from the viewpoint of efficient information management.

  FIG. 25B shows an example of a correspondence table stored in the history information database 55 that associates each consultation history with a preset burden ratio of each bearer. Based on the correspondence table and the visit history, the visit history is reflected in the calculation of a burden to be described later.

(Medical cost calculation server)
As described above, the medical cost calculation server 53 has a function of accepting changes in the contents in the consultation history information database 55. The configuration of the medical cost calculation server 53 is, for example, as shown in FIG.

  FIG. 26 shows a schematic configuration of the medical cost calculation server 53 according to the fourth embodiment. In the medical cost calculation server 53 shown in the figure, a reception history registration means 538 is further added to the configuration of the medical cost calculation server 53 shown in FIG.

  The reception history registration unit 538 has a function of creating a medical examination history at a medical institution for each individual based on the information received from the medical institution by the medical expense request receiving unit 531 and registering it in the medical examination history information database 55.

(Medical cost burden calculation and settlement)
Next, the medical cost burden calculation process reflecting the medical examination history information will be described with reference to FIGS. 25A, 25B and FIG. The processes in FIGS. 9A to 9 are the same as those in the first embodiment, and will be described from step (5) in order to avoid duplication.

  After the provisional settlement in step (4), the medical cost calculation server 53 receives the calculation information of the patient from the calculation information database 50 and the correspondence table of the patient's visit history and the corresponding burdenee from the history information database 55. (5).

  At this time, in the information shown in FIGS. 2A, 2B, 25A, 25B, etc., only a part of the required information may be extracted, or all the burden ratio information related to the patient may be extracted. good.

  The medical cost calculation server 53 determines to which burden the person should charge the medical cost from the information on the burdened person obtained from the calculation information database 50 and the medical cost request received from the medical cost management server 32. Calculation is performed by the calculation means 534 (6).

  FIG. 25C is a diagram for explaining the calculation of the medical cost burden reflecting the medical examination history. Similar to FIG. 23B, a predetermined patient who is an insured person of α insurance undergoes endoscopic surgery at Hospital A. The burden ratio data in the case of When FIG. 25C and FIG. 23B are compared, the burden ratio of α insurance is 3% higher. This is because the visit history information that the predetermined patient has received a close examination within one month is reflected in the medical cost burden calculation process based on the correspondence table shown in FIG. 25B.

  In this case, since the burden items of the α insurance are complex, it is preferable that the contents of the items can be displayed. For example, it is preferable that a list of burden contents shown in FIG. 25D is displayed by clicking the α insurance column in the personal burden ratio data shown in FIG. 25C on a predetermined terminal or the like. The calculated information is registered in the billing information in the medical cost settlement result information database 52.

  Subsequently, the medical cost calculation server 53 requests a burden amount from each bearer by the medical cost billing means 535 based on the calculated billing information (7).

  When payment of the burden amount from each bearer is completed in response to the request for the burden amount, a series of medical cost settlement by this system is completed.

  According to the configuration described above, the following effects can be expected.

  The medical examination history of the insured person can be easily and quickly reflected in the insurance system. From the bearer (for example, the insurer), the insurance plan can be enriched and the service can be enhanced. Therefore, the insured person (patient) can be guided financially.

  In addition, the bearer can refer to the consultation history information quickly and easily. Consultation history information can be referenced at any time. For example, when the burdensome person updates the burden calculation information using the method described above, the patient's visit management history information is displayed. It can be set as burden calculation information reflecting an individual's health condition.

  FIG. 27 shows an example of a screen display in which consultation history information is added to the contents shown in FIG. According to the screen display shown in the figure, the medical cost bearer can change the burden ratio with reference to the consultation history displayed at the same time.

  Note that the change of the burden ratio with reference to the consultation history information may be configured such that the apparatus is automatically executed regardless of human work. Automatic change by this device is realized by a configuration in which the reception history registration means 538 of the medical cost calculation server 53 automatically determines from the predesignated conditions and the visit history information and changes the calculation information database 50. it can. Specifically, a configuration is conceivable in which the reception history registration unit 538 automatically updates the content of the calculation information database 50 based on whether or not the patient has been consulted within one month.

(Fifth embodiment)
Next, a fifth embodiment of the medical cost burden calculation system according to the present invention will be described. The medical cost burden calculation system according to the fifth embodiment discloses a system in which the system 9 according to the third embodiment and the system 10 according to the fourth embodiment are combined.

  First, the configuration of the medical expense burden calculation system according to the fifth embodiment will be described with reference to FIG.

  FIG. 28 shows a schematic configuration diagram of a medical cost burden calculation system according to the fifth embodiment.

  As shown in FIG. 28, the medical cost burden calculation system includes a first system 3, a second system 5, a third system, a fourth system 7, and a fifth system 8. A consultation history information database 55 and a health information database 54 are provided on the second system. The schematic configuration of the medical calculation server 53 is as shown in FIG.

(Medical cost burden calculation and settlement)
The medical cost burden calculation and settlement by this system is a combination of the contents described in the third and fourth embodiments. That is, in the calculation of the medical cost burden, it is only necessary to reflect the health management information and the consultation information in the manner described in the third and fourth embodiments and settle each burden according to the calculation.

  Moreover, when a burden person changes the burden ratio according to each item in the consultation history information database 55 and the health information database 54, it implement | achieves in the following forms, for example.

  FIG. 30 shows an example of a screen display in which consultation history information and health information are added to the contents shown in FIG. According to the screen display shown in the figure, the medical cost bearer can change the burden ratio with reference to the consultation history or health information displayed at the same time. Moreover, the automatic change of the burden ratio with reference to the medical examination history information and health information can be realized by combining the contents described above.

  According to the medical cost burden calculation system having the above-described configuration, when the burden person updates the burden calculation information, it is possible to simultaneously display the visit history and health information of the patient. Therefore, the burdened person can easily reflect the patient's individual health condition and efforts for health management in the burden amount calculation information.

(Sixth embodiment)
In each of the above-described embodiments, a case has been described in which a calculation company other than the hospital and the insurance company executes the medical cost calculation process. In contrast, in the sixth embodiment, a case where a hospital that provides a medical practice performs a medical cost calculation process will be described.

  FIG. 31 shows a schematic configuration of a medical cost burden calculation system according to the sixth embodiment. As shown in the figure, in this embodiment, since the hospital performs the calculation process, the first system 3 in the hospital 15 newly includes a medical cost calculation information database 50, a medical institution information database 51, and a settlement result information database. 52, a medical cost management / calculation server 33 having functions of a medical cost management server 32 and a medical cost calculation server 53 is provided. Each function is as described above.

  Further, the first system can be connected to the burdener side terminal 70 on the fourth system via the third system. Note that the payment of medical expenses and the like between the hospital and the patient may be an electronic transaction via the third system, but in this embodiment, payment at a window after the end of the medical practice is assumed.

(Medical cost burden calculation and settlement)
Next, a burden calculation process and a settlement process performed by this system will be described. To describe the general flow, information identifying the patient is provided by the patient who received the medical practice, for example, at the accounting counter of the hospital. The medical cost management / calculation server 33 installed in the hospital calculates a burden amount borne by each of the patient, the hospital, and the bearer based on various pieces of calculation information. Then, only the patient's own burden is billed at the accounting window, and the settlement is made by separately billing the burden corresponding to the bearer via the third system.

  This will be described in more detail with reference to FIG.

  FIG. 32 is a diagram showing the flow of the burden calculation processing and settlement processing realized by this system.

  In FIG. 32, first, the reading apparatus 300 obtains the patient ID (1). This patient ID is transmitted to the medical cost management server 32.

  Next, the medical cost management / calculation server 33 acquires medical cost information related to the input patient ID from the medical cost database 31 (2).

  The medical cost management / calculation server 33 acquires medical cost calculation information related to the input patient ID from the medical cost database 50 (3).

  The medical cost management / calculation server 33 calculates the burden paid by each bearer in the medical cost calculation means 532 (see FIG. 6) (4). The calculated information is registered in the billing information of the medical cost settlement result information database 52.

  Subsequently, at the accounting window, the calculated amount to be borne by the patient is charged to the patient. Also, the medical cost management / calculation server 33 requests the burden amount from the burdener by the medical cost billing means 535 based on the calculated billing information (7).

  When payment of the burden from the bearer is completed in response to the request for the burden, a series of medical expenses settlement by the system is completed.

  Even with the configuration described above, the same effects as those of the first embodiment can be obtained. In addition, in the medical cost burden calculation / settlement process reflecting the change of each burdener's burden, health management information or medical history, the components added in each embodiment are added to the first system. It can be realized.

(Seventh embodiment)
Next, an embodiment in which a burdener such as an insurance company also serves as a calculation company will be described. In this case, the second system in the first to fifth embodiments described above is merely deployed on the insurer's network, and the contents are almost the same as the contents of the description. . Therefore, the description is omitted.

(Eighth embodiment)
Next, an eighth embodiment of the medical cost burden calculation system according to the present invention will be described. In the medical cost burden calculation system according to the eighth embodiment, a medical recipient receiving medical services obtains information on the medical cost burden ratio of each medical cost bearer at his / her own terminal via an arbitrary network. Disclose possible systems.

  First, the configuration of the medical cost burden calculation system according to the eighth embodiment will be described with reference to FIG.

  FIG. 33 shows a schematic configuration diagram of the medical cost burden calculation system 11 according to the eighth embodiment.

  When the medical cost burden calculation system 11 shown in FIG. 33 is compared with the medical cost burden calculation system 10 shown in FIG. 24, there are two major differences. The first point is that the medical cost calculation server 53 in the second system has a function of accepting a request for presentation of information on the burden ratio of each medical cost bearer (hereinafter referred to as burden ratio information), and burden allocation information for which there is a request. It has a function to transmit. The second point is that a terminal capable of presenting a medical cost burden ratio is provided on the fifth system by any medical recipient or the like. Only new components will be described below to avoid duplication.

(Medical cost calculation server)
As described above, the medical cost calculation server 53 has a function of accepting a request for presentation of information regarding the burden ratio of each medical cost bearer (hereinafter referred to as burden ratio information) and a function of transmitting burden allocation information for which there is a charge. The configuration of the medical cost calculation server 53 is, for example, as shown in FIG.

  FIG. 34 shows a schematic configuration of the medical cost calculation server 53 according to the eighth embodiment. The medical cost calculation server 53 shown in the figure includes the medical cost calculation server 53 shown in FIG. 5 in addition to the medical cost share ratio presentation request receiving means 540 (hereinafter referred to as presentation request receiving means 540), the medical cost. A burden ratio transmitting unit 541 (hereinafter referred to as a burden ratio transmitting unit 541) is added.

  The presentation request accepting unit 540 accepts a presentation request for a medical cost burden ratio transmitted from, for example, a terminal on the fifth system. In response to the presentation request, the presentation request receiving means 540 acquires the burden calculation information of the corresponding medical recipient from the burden calculation information database 50 and creates the burden ratio information.

  The burden ratio transmitting unit 541 transmits the burden ratio information created by the presentation request receiving unit 540 to the terminal on the fifth system.

(Terminals that can present the medical expenses share)
As the terminal 81 (hereinafter, the presentation terminal 81) capable of presenting a medical cost burden ratio, a personal computer, a portable computer, a portable phone, a network appliance, and the like are conceivable. Each medical recipient or the like can access the medical cost burden calculation system 6 from the presentation terminal 81 and acquire his / her burden ratio information and the like.

  FIG. 35 shows a schematic configuration of the presentation terminal 81. As shown in FIG. 35, the presentation terminal 81 includes a CPU 800, a recipient information receiving unit 801, a recipient information transmitting unit 802, a burden rate presenting request unit 803, a burden rate receiving unit 804, and a burden rate presenting unit 805. Yes.

  The CPU 800 performs overall control of the presentation terminal 81.

  The recipient information receiving unit 801 is a unit for receiving information for uniquely identifying a medical recipient who wants to display a medical cost burden ratio. Information for uniquely identifying a medical recipient includes an insured number.

  The recipient information transmission unit 802 is a unit that transmits the medical recipient information received by the recipient information reception unit 801 to the medical cost calculation server.

  The burden rate presentation requesting unit 803 is a unit for requesting the medical cost calculation server 53 to present the medical cost burden rate information regarding the medical recipient.

  The burden ratio receiving means 804 receives the burden ratio information of the medical recipient's medical expenses transmitted by the burden ratio transmitting means 541 of the medical expense calculation server 53.

  The burden ratio presenting means 805 is means for presenting the burden ratio information received by the burden ratio receiving means 804 to the user on the terminal side. As a method of presenting the burden ratio information, display or voice output is generally used.

(Acquisition of medical cost burden calculation information)
Next, acquisition of medical cost burden calculation information, which is the subject of the present embodiment, will be described with reference to FIG.

  FIG. 37 is a diagram showing the flow of processing until a certain medical recipient requests the medical cost calculation server 53 to present the burden ratio information about itself and presents the corresponding burden ratio information to the presentation terminal 81. It is.

  In FIG. 37, first, the medical recipient inputs information for uniquely identifying himself / herself on the screen for requesting the burden ratio information at the presentation terminal 81, and requests the burden ratio information from the calculation server 53.

  FIG. 36A shows an example of a screen displayed on the presentation terminal 81 when requesting the burden ratio information. In the screen shown in the figure, the insured number is used as information for uniquely identifying the medical recipient. In the screen shown in FIG. 34, the medical recipient inputs the insured number and password, and clicks the send button with the mouse. Through the above processing, the input identification information is received by the recipient information receiving unit 801 and transmitted to the medical cost calculation server 53 by the recipient information transmitting unit 802 as the recipient identification information. The transmitted recipient identification information is received by means (not shown) for receiving the recipient identification information of the medical cost calculation server 53, and it is determined whether or not the recipient identification information is acceptable. At this time, when it is determined that it can be accepted, the presentation request transmission unit 803 of the presentation terminal 81 makes a presentation request of the burden ratio to the presentation request reception unit 540 in the medical cost calculation server 53.

  Subsequently, the presentation request receiving means 540 in the medical cost calculation server 53 receives the transmitted request for the burden ratio, and acquires the medical cost burden ratio information of the medical recipient from the burden calculation information database 50. The acquired medical cost burden ratio information is transmitted to the presentation terminal 81 by the burden ratio transmission means 541 (2).

  The transmitted burden ratio information is received by the burden ratio receiving means 803 of the presenting terminal 81 and displayed by the presenting means 805 (3).

  FIG. 36B shows an example of burden ratio information displayed on the presentation terminal 81. In this case, since it is assumed that the information acquirer on the presentation terminal 81 side is a medical recipient, the medical cost burden ratio in FIG. 36B is expressed as a discount rate. For example, the reason why the discount rate of hospital B is expressed as a range of 5 to 20% is that the discount rate varies depending on conditions.

  Thus, it is preferable that the burden information presented on the presentation terminal 81 can further display the detailed information of the discount rate in a hierarchical manner. For example, as shown in FIG. 36B, when the hospital B is selected to display the detailed information, clicking the details button with the mouse may display the detailed information as shown in FIG. 36C. preferable.

  FIG. 36C shows an example of detailed information on the discount rate of hospital B (for example, what is the discount rate of medical practice and who is paying it). According to the detailed information, for example, XX insurance pays 5% of the medical care recipient's contribution to all medical activities, and XX insurance pays 20% of the medical care recipient's contribution to endoscopic surgery. Can be seen as being borne by Hospital B. The medical recipient can know from the display in FIGS. 36B and 36C that, for example, if the medical recipient desires an endoscopic operation, it is cheaper to use Hospital B.

  As described above, by presenting medical cost burden ratio information to each medical recipient, the medical recipient can select a medical institution. Furthermore, the medical cost bearer can more effectively provide financial guidance to the medical recipient.

  Here, the case where these functions are added to the first embodiment has been described as an example. However, the configuration shown in any of the first to fifth embodiments may be added to this system.

  Next, a modification of this embodiment will be described.

  As described above, the burden calculation information database 50 on the second system includes information on each medical recipient, information on a medical cost bearer for each medical recipient, information on a burden ratio of each bearer, each burden Various information such as information on the amount of money is stored (see FIG. 2). Therefore, the burden ratio information can be searched for each medical recipient by adding further conditions.

  FIG. 38 is a configuration example of the presentation terminal 81 that can search the burden ratio information under various conditions. As shown in FIG. 38, a burden ratio search condition specifying unit 806 is newly provided.

  The burden ratio search condition designating unit 806 has a function capable of designating a desired search condition when acquiring the burden ratio of the medical recipient.

  FIG. 39 shows an example of a screen displayed on the presentation terminal 81 when a search condition is specified based on the function of the burden ratio search condition specifying unit 806.

  In the screen shown in FIG. 39, by designating any one or more of the hospital name, department, symptom, and area, the designated item is set as a search condition for the burden ratio information. After designating a desired item, clicking the search button at the lower right in the figure with a mouse causes a share rate presentation request to be sent to the medical cost calculation server together with the designated condition.

  The presentation request accepting means 540 on the medical cost calculation server 53 side receives the request and the condition, and acquires cost burden ratio information that matches the specified condition from the burden calculation information database 50. The acquired burden ratio information is transmitted to the presentation terminal 81 and displayed by the above-described operation.

  FIG. 39 shows a screen display example for designating one hospital. However, the present invention is not limited to this, and a configuration in which a plurality of hospitals are searched may be used, and another search condition such as the location of a hospital may be included in the search condition.

  As described above, the convenience of information collection can be improved by specifying the search condition when requesting the medical expense calculation server 53 to present the burden ratio information. Therefore, it is possible to view only necessary information more easily. For example, if a diagnosis department is not specified as a search condition, information on internal medicine may be presented even though the user wishes to undergo surgery. However, by specifying the diagnosis department as a search condition, it becomes possible to acquire only the burden ratio information related to surgery.

  The medical recipient can also display and display the individual burden ratio table relating to himself / herself shown in FIG. 7B or FIG. 23B on the presentation terminal 81. According to such a configuration, the medical recipient can simulate his / her medical cost burden in various patterns in advance. As a result, the choice of medical institutions, insurance companies, etc. will be expanded.

(Ninth embodiment)
Next, a ninth embodiment of the medical cost burden calculation system according to the present invention will be described. In the medical cost burden calculation system according to the ninth embodiment, a system is disclosed in which a patient or the like who receives medical services can acquire information on the results of each medical institution at his / her own terminal via an arbitrary network. .

  First, the configuration of the medical cost burden calculation system according to the ninth embodiment will be described with reference to FIG.

  FIG. 40 shows a schematic configuration diagram of the medical cost burden calculation system 12 according to the ninth embodiment.

  When comparing the medical cost burden calculation system 12 shown in FIG. 40 with the medical cost burden calculation system 11 shown in FIG. 31, there are three major differences. The first point is that a medical institution performance information database 57 is provided on the second system. The second point is that the medical cost calculation server 53 in the second system has a function of acquiring medical institution performance information in the medical institution performance information database 57. The third point is that the presentation terminal 81 has a function of receiving and presenting performance information regarding a medical institution transmitted from the medical cost calculation server 53. Only new components will be described below to avoid duplication.

(Medical institution results information database)
The medical institution result information database 57 stores statistical information on the treatment results of each medical institution, the cure rate, etc., information for introducing each medical institution (hereinafter referred to as medical institution result information). Information introducing each medical institution may be created independently by each medical institution or may be created by a third party institution.

  In this embodiment, the medical institution performance information database 57 is provided on the second system. However, any computer network may be used as long as access from a medical cost calculation server described later is possible.

(Medical cost calculation server)
As described above, the medical cost calculation server 53 has a function of acquiring medical institution performance information (hereinafter referred to as performance information) in the performance information database 57. The configuration of the medical cost calculation server 53 is, for example, as shown in FIG.

  FIG. 41 shows a schematic configuration of the medical cost calculation server 53 according to the seventh embodiment. The medical cost calculation server 53 shown in the figure includes the medical cost calculation server 53 shown in FIG. 32, a medical institution performance information transmission means 542 (hereinafter referred to as performance information transmission means 542), and medical institution performance information. An acquisition unit 543 (hereinafter, result information acquisition unit 543) is added.

  The result information transmitting unit 542 acquires medical institution result information from the result information database 57.

  The record information acquisition unit 543 transmits the medical institution record information acquired by the record information transmission unit 542 to the presentation terminal 81.

(Presentation terminal)
The presentation terminal 81 has a function of receiving and presenting performance information regarding a medical institution transmitted from the medical cost calculation server 53. The configuration of the presentation terminal 81 is, for example, as shown in FIG.

  FIG. 42 shows a schematic configuration of the presentation terminal 81 according to the seventh embodiment. As shown in the figure, in addition to the configuration shown in FIG. 35, the presentation terminal 81 includes a medical institution performance information receiving unit 809 (hereinafter, performance information receiving unit 809) and a medical institution performance information presentation unit 810 (hereinafter, Result information presenting means 810).

  The result information receiving unit 809 receives the medical institution result information transmitted from the medical cost calculation server 53.

  The achievement information presenting means 810 presents the medical institution achievement information received by the achievement information receiving means 809.

  FIG. 43 shows an example of medical institution performance information presented by the performance information presentation means 810. As shown in the figure, the medical institution performance information is preferably displayed in a form added to the medical cost burden ratio information for each medical institution.

  According to the configuration described above, not only the financial information on the medical cost burden ratio but also the medical treatment results and the information representing the characteristics of each medical institution can be provided in a unified manner so that the medical recipient can It becomes possible to select an appropriate medical institution.

  Although the present invention has been described based on the embodiments, those skilled in the art can come up with various changes and modifications within the scope of the idea of the present invention. It is understood that it belongs to the scope of the present invention. For example, as shown below, various modifications can be made without changing the gist thereof.

(1) The medical cost calculation server 53 shown in each of the above embodiments may be a logical server. In other words, each means of the medical cost calculation server does not necessarily need to be on one computer, and each means of the medical cost calculation server described in each embodiment is distributed and arranged on computers connected to each other. Also good.

(2) The terminal provided on the fourth system or the fifth system may be a dedicated terminal that does not need to download the above-described program.

(3) In each of the third to fifth embodiments, the amount calculation information changing means 536 of the medical cost calculation server 53 is determined according to the contents of the database (health information, visit history information). Explained the configuration to update the contents of the database. The timing of this update is determined in advance when calculating the billing medical expenses (when the data is obtained from the burden calculation information database) or when the contents of the health information and the visit history information database are changed. Arbitrary time may be sufficient.

(4) In the sixth or seventh embodiment, the burden calculation information changing means 536 of the medical cost calculation server 53 changes the burden calculation information database 50 contents according to the contents of the database (health information, medical history information). Explained to update. This update does not necessarily require the burden calculation information changing means 536 to directly update the contents of the burden calculation information database 53. For example, the burden calculation means 534 may dynamically calculate the billed medical expenses from the contents of the burden calculation information database 50, health information, and consultation history information.

  The present invention is not limited to the above-described embodiment, and various modifications can be made without departing from the spirit of the invention in the implementation stage. In addition, the embodiments may be combined as appropriate as possible, and in that case, the combined effect can be obtained. Furthermore, the above embodiments include inventions at various stages, and various inventions can be extracted by appropriately combining a plurality of disclosed constituent elements. For example, even if some constituent requirements are deleted from all the constituent requirements shown in the embodiment, the problem described in the column of the problem to be solved by the invention can be solved, and the effect described in the column of the effect of the invention If at least one of the following is obtained, a configuration in which this configuration requirement is deleted can be extracted as an invention.

FIG. 1 shows a schematic configuration diagram of a medical cost burden calculation system 1 according to the first embodiment. FIG. 2A is a diagram schematically showing information for calculating a burden amount, which is stored in the burden amount calculation information database 50, respectively. FIG. 2B is a diagram schematically showing information for calculating the burden amount, which is stored in the burden amount calculation information database 50. FIG. 2C is a diagram schematically showing information for calculating the burden amount, which is stored in the burden amount calculation information database 50. FIG. 2D is a diagram schematically showing information for calculating a burden amount stored in the burden amount calculation information database 50. FIG. 3 shows an example of medical institution information stored in the medical institution information database 51. FIG. 4A shows an example of medical institution information stored in the settlement result information database 52. FIG. 4B shows an example of medical institution information stored in the settlement result information database 52. FIG. 4C shows an example of medical institution information stored in the settlement result information database 52. FIG. 5 is a diagram showing a schematic configuration of the medical cost calculation server 53. FIG. 6 is a diagram for explaining an example of a payment burden calculation process executed in the medical cost calculation means 532. FIG. 7A is a diagram for explaining a medical cost calculation process executed by the burden calculation unit 534. FIG. 7B is a diagram for explaining a medical cost calculation process executed by the burden calculation unit 534. FIG. 8 shows an example of a screen displayed on the monitor on the medical expense management server 32 side when the medical expense request information is transmitted from the medical expense management server 32 to the medical expense calculation server 53. FIG. 9 is a diagram showing a processing flow of the present system when a medical institution charges a medical fee to a medical recipient. FIG. 10A shows an example of medical institution information stored in the settlement result information database 52. FIG. 10B shows an example of medical institution information stored in the settlement result information database 52. FIG. 10C shows an example of medical institution information stored in the settlement result information database 52. FIG. 11 shows an example of payment information to the medical institution in the medical expense settlement result information database 52 that is updated when the payment process is completed. FIG. 12 shows an example of billing information in the medical expenses settlement result information database 52 that is updated when the calculation process is completed. FIG. 13 shows a schematic configuration diagram of the medical cost burden calculation system 6 according to the second embodiment. FIG. 14 shows a schematic configuration of the medical cost calculation server 53. FIG. 15 shows an example of a screen displayed on the display means of the burdener side terminal 70 when requesting the burden amount calculation information data. FIG. 16 shows an example of burden calculation information from the calculation information changing means 536 displayed on the burdener side terminal 70. FIG. 17 is a diagram showing a flow of processing of the present system when a certain medical cost bearer changes the burden ratio of a specific patient by the medical cost burden calculation system 6. FIG. 18 shows a schematic configuration diagram of a medical cost burden calculation system 9 according to the third embodiment. FIG. 19 shows a schematic configuration of the medical cost calculation server 53 according to the third embodiment. FIG. 20 shows an example of health information stored in the information database 54. FIG. 21 is a diagram showing a flow of processing when new health information is registered in the information database 54 from the arbitrary terminal 80 by the medical cost burden calculation system 9. FIG. 22A shows an example of a screen displaying the health information currently registered in the information database 54 and the new health information input field displayed on the health manager side terminal 80. FIG. 22B shows an example of a screen display in which health information is added to the content shown in FIG. FIG. 23A shows an example of a correspondence table stored in the information database 54 that associates various health cares with preset burden ratios of each bearer. FIG. 23B is a diagram for explaining medical cost burden calculation reflecting health management information. FIG. 23C shows an example of a form for displaying a list of burden items of α insurance. FIG. 24 shows a schematic configuration diagram of the medical cost burden calculation system 10 according to the fourth embodiment. FIG. 25A shows an example of history information related to an individual medical consultation stored in the consultation history information database 55. FIG. 25B shows an example of a correspondence table stored in the history information database 55 and corresponding to various visit histories and preset burden ratios of each bearer. FIG. 25C is a diagram for explaining medical cost burden calculation reflecting medical examination history information. FIG. 25D shows an example of a form for displaying a list of burden items of α insurance. FIG. 26 shows a schematic configuration of the medical cost calculation server 53 according to the fourth embodiment. FIG. 27 shows an example of a screen display in which consultation history information is added to the contents shown in FIG. FIG. 28 shows a schematic configuration diagram of a medical cost burden calculation system according to the fifth embodiment. FIG. 29 shows a schematic configuration of the medical calculation server 53. FIG. 30 shows an example of a screen display in which consultation history information and health information are added to the contents shown in FIG. FIG. 31 shows a schematic configuration of a medical cost burden calculation system according to the sixth embodiment. FIG. 32 is a diagram showing the flow of the burden calculation processing and settlement processing realized by this system. FIG. 33 shows a schematic configuration diagram of the medical cost burden calculation system 11 according to the eighth embodiment. FIG. 34 shows a schematic configuration of the medical cost calculation server 53 according to the eighth embodiment. FIG. 35 shows a schematic configuration of the presentation terminal 81. FIG. 36A shows an example of a screen displayed on the presentation terminal 81 when requesting the burden ratio information. FIG. 36B shows an example of the burden ratio information displayed on the presentation terminal 81. FIG. 36C shows an example of detailed information on the discount rate of Hospital B. FIG. 37 is a diagram showing the flow of processing until a certain medical recipient requests the medical cost calculation server 53 to present the burden ratio information about itself and presents the corresponding burden ratio information to the presentation terminal 81. It is. FIG. 38 is a configuration example of the presentation terminal 81 that can search the burden ratio information under various conditions. FIG. 39 shows an example of a screen displayed on the presentation terminal 81 when a search condition is specified based on the function of the burden ratio search condition specifying unit 806. FIG. 40 is a schematic configuration diagram of the medical cost burden calculation system 12 according to the seventh embodiment. FIG. 41 shows a schematic configuration of the medical cost calculation server 53 according to the seventh embodiment. FIG. 42 shows a schematic configuration of the presentation terminal 81 according to the seventh embodiment. FIG. 43 shows an example of medical institution performance information presented by the performance information presentation means 810.

Explanation of symbols

1 ... 3 ... 5 ..., 7 ..., 8 ..., 9 ..., 12 ..., 15 ..., 30 ..., 31 ... medical cost database, 32 ... medical cost management server, 50 ... medical cost calculation information database, 51 ... Medical institution information database, 52 ... Settlement result information database, 53 ... Medical cost calculation server, 54 ... Health information database, 55 ... Consultation history information database, 70 ... Payer side terminal, 80 ... Health manager terminal, 81 ... Medical cost Load ratio presentation terminal, 300 ... portable electronic storage medium reading device, 301 ... portable electronic storage medium, 530, 800 ... CPU, 531 ... medical cost request receiving means, 532 ... medical cost calculation means, 533 ... medical cost payment means 534... Burden amount calculating means 535. Medical cost claiming means 536. Calculation information receiving means 537. Health information registering means 538. DESCRIPTION OF SYMBOLS 1 ... Burden ratio transmission means, 543 ... Medical institution performance information acquisition means, 801 ... Medical recipient information reception means, 802 ... Recipient information transmission means, 803 ... Burden ratio presentation request transmission means, 804 ... Burden ratio reception means, 805 ... burden ratio presenting means, 806 ... burden ratio search condition specifying means, 809 ... medical institution performance information receiving means, 810 ... medical institution performance information presenting means

Claims (7)

A first computer system provided on the patient side who is a candidate for receiving a medical practice, and the first computer system connected to the first computer system via a network. A medical cost information providing system comprising: a second computer system that provides information including a ratio to the first computer system;
The first computer system includes:
An input means for inputting specific information for specifying a medical institution and medical practice in the medical institution;
A first transmission unit configured to transmit the specific information to the second computer system via the network when the specific information is input;
The second computer system includes:
Storage means for storing burden information that the insurer defines for each medical institution the burden ratio or amount of the insurer regarding medical expenses;
When the specific information is received, the storage means is searched, and when the patient receives medical practice at the medical institution specified by the received specific information, A calculation means for simulating various burden patterns;
When the simulation is executed, based on the simulation result, generating means for generating a list for displaying a list in association with the burden ratio or the burden amount of the medical institution and the insurer,
When the list is generated, second transmission means for transmitting the list to the first computer system and providing it to the patient via the network;
First receiving means for receiving a change instruction from an insurer that changes the stored burden information via the network;
A change means for changing the burden information stored in the storage means based on the change instruction when the change instruction is received;
Therefore, it should be motivational information that the insurer guides the patient to the prescribed medical institution,
Medical expenses information providing system characterized by The first computer system includes:
Second receiving means for receiving the transmitted list;
When the list is received, display means for displaying the list;
Further having
The medical cost information providing system according to claim 1.   The medical cost information providing system according to claim 1 or 2, wherein the generating unit generates the list for displaying a list of medical institutions, insurers, and the burden ratios or amounts according to medical practices. .   The insurer shall pay at least a part of medical expenses related to various medical practices of the insurer on behalf of the medical institution, insurer, health insurance association, public organization, national or local government or other insurer who performs the medical act. The medical cost information providing system according to any one of claims 1 to 3, wherein the medical cost information providing system is a person who bears. The second computer system further includes calculation means for calculating a medical cost to be paid by the patient for each medical practice in a medical institution based on the result of the simulation,
The second transmission means transmits the calculated medical cost to the first computer system via the network instead of or together with the list;
The medical cost information providing system according to any one of claims 1 to 4, characterized in that:   The calculation means also refers to a database storing the medical cost burden ratio for each insurer according to the patient's various personal information and the personal information for each patient, and calculates the medical cost to be paid by the patient. 6. The medical cost information providing system according to claim 5, wherein calculation is performed for each medical institution and for each piece of information related to the medical practice.   The calculation means pays by the insurer with reference to a database that stores a burden ratio for each insurer who bears at least a part of the medical expenses according to various medical examination histories and a reception history for each patient. 6. The medical cost information providing system according to claim 5, wherein a medical cost to be calculated is calculated for each medical institution and for each information related to the medical practice.

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