基于风险控制的医院门诊预付费自动结算方法研究

Research on automatic settlement method of prepaid hospital outpatient service based on risk control

为了提高医院门诊预付费自动结算的风险管控能力,提出一种基于风险控制的医院门诊预付费自动结算方法。构建基于量化回归分析模型的医院门诊预付费自动结算风险控制模型,采用描述性统计分析方法进行医院门诊预付费自动结算大数据采样,对采样的医院门诊预付费自动结算数据采用最小二乘拟合方法进行数据信息化重构,构建医院门诊预付费自动结算数据的定量回归分析模型,提取医院门诊预付费风险控制大数据的关联规则量,根据关联规则分布集进行风险预测,计算医院门诊预付费自动结算的风险概率,根据概率分布模型进行风险控制。实证分析结果表明,采用该方法进行医院门诊预付费自动结算的风险控制性能较好,风险预测的收敛性较高,提高了医院门诊预付费自动结算风险概率预测和决算能力。

In order to improve the risk control ability of hospital outpatient prepaid automatic settlement,a method based on risk control is proposed.Based on quantitative regression analysis model,a risk control model of hospital outpatient prepaid automatic settlement is constructed,and big data sampling is carried out by using descriptive statistical analysis method.The data of prepaid automatic settlement in hospital outpatient service is reconstructed by least square fitting method,and the quantitative regression model of automatic settlement data of outpatient service is constructed.Extracting the quantity of big data’s association rules,forecasting the risk according to the distribution set of association rules,calculating the risk probability of outpatient prepaid automatic settlement,and carrying out risk control according to the probability distribution model.The results of empirical analysis show that this method has better risk control performance and higher convergence of risk prediction,and improves the ability of risk probability prediction and final accounting of hospital outpatient prepaid automatic settlement.