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An Ensemble Methods for medical insurance Costs Prediction Task

Computers, Materials & Continua 2022年第2期70卷 3969-3984页

作者： Nataliya Shakhovska Nataliia Melnykova Valentyna Chopiyak Michal Gregus ml Department of Artificial Intelligence Lviv Polytechnic National UniversityLviv79013Ukraine Department of Clinical Immunology and Allergology Danylo Halytsky Lviv National Medical UniversityLviv79010Ukraine Faculty of Management Comenius UniversityBratislava81499Slovakia

The paper reports three new ensembles of supervised learning predictors for managing medical insurance *** open dataset is used for data analysis methods *** usage of artificial intelligence in the management of financial risks will facilitate economic wear time and money and protect patients’*** learning is associated withmany expectations,but its quality is determined by choosing a good algorithm and the proper steps to plan,develop,and implement the *** paper aims to develop three new ensembles for individual insurance costs prediction to provide high prediction *** coefficient and Boruta algorithm are used for feature *** boosting,stacking,and bagging ensembles are built.A comparison with existing machine learning algorithms is *** modes based on regression tree and stochastic gradient descent is *** CART and Random Forest algorithms are *** boosting and stacking ensembles shown better accuracy than *** tuning parameters for boosting do not allow to decrease the RMSE ***,bagging shows its weakness in generalizing the *** stacking is developed using K Nearest Neighbors(KNN),Support Vector Machine(SVM),Regression Tree,Linear Regression,Stochastic Gradient *** random forest(RF)algorithm is used to combine the *** hundred trees are built *** Square Error(RMSE)has lifted the to 3173.213 in comparison with other *** quality of the developed ensemble for RootMean Squared Error metric is 1.47 better than for the best weak predictor(SVR).

关键词： Healthcare medical insurance prediction task machine learning ensemble data analysis

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Software Process Modeling with UML in Development of medical insurance MIS

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Wuhan University Journal of Natural Sciences 2001年第Z1期6卷 224-228页

作者： Li Si guang, Lin Zi yu ,Tang Sheng qun, Xiao Shao wu State Key Lab of Software Engineering, Wuhan University, Wuhan 430072,China State Key Lab of Software Engineering Wuhan University Wuhan China

This paper describes how to use the Unified Modeling Language (UML) to modeling software processes in medical insurance MIS, and compares UML Modeling method with classic PO(Process Oriented) Modeling method. It indicates that the whole performance of application system model described by UML is much better than the one described by PO.

关键词： UML Modeling method Process Oriented Object Oriented medical insurance

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Impacts of National Basic medical insurance Drug List adjustment on drug utilization in China: an interrupted time series study

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Journal of Chinese Pharmaceutical Sciences 2015年第11期24卷 754-763页

作者：翁庚马莉莉刘伊管晓东史录文北京大学医学部药学院药事管理与临床药学系北京100191 北京大学医学管理国际研究中心北京100191

Under Chinese medicine and health care system, Medicine Catalogue for National Basic medical insurance（2009） was issued in 2009 in China to fulfill the basic drug demands of the insured Chinese and to control the medical expenses. In this study, the influence of the list adjustment on drug utilization was investigated. With the comparison between inpatients＇ use of drugs before and after adjustment of Basic medical insurance Drug List, we classified the drugs adjusted in national list into six categories： class A to class B, class B to class A, class A to class C, class B to class C, class C to class A, and class C to class B（class A referring to overall insured drugs, class B referring to partial reimbursement drugs, class C referring to self-funded drugs in China）, and drug utilization and expenditure were analyzed with time series model. We analyzed the overall expenditure and average expenditure per 10 000 people based on the comparison before and after the adjustment of 2009 Basic medical insurance Drug List. The drug expenditure from class A to class B was decreased by 13.87% of overall expenditure and 16.37% of average expenditure per 10 000 people, and it was decreased by 38.74% and 48.03% from class A to class C; respectively, the drug expenditure from class B to class A was increased by 74.12% and 94.52%, while it was reduced by 19.79% and 14.52% from class B to class C; expenditure declined by 31.77% and 36.22% from class C to class A, and expenditure was increased by 12.42% and 22.05% from class C to class B, respectively, both were lower than before. The adjustment of National Basic medical insurance Drug List reduced the overall drug expenditure.

关键词： medical insurance Drug list Drug utilization Interrupted time series

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A Study of medical insurance With Big Data in Taiwan

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Management Studies 2018年第5期6卷 402-413页

作者： Jhih-Ling Chiu Chun-Ya Chang Ming Chuan University Taipei Taiwan Ming Chuan University Tokio Marine Newa insurance Co. Ltd. Taipei Taiwan

The structures of numerous industries, including the insurance industry, have been altered by the ongoing development of associated technologies. As the insurance industry undergoes this period of technology transformation, it is important to recognize the key role that big data play in the industry. Most critically, the industry could not function without the utilization of big data, which explains to a large extent why every insurance company maintains its own numeric database. Relatedly, Taiwan＇s Bureau of National Health insurance recently established the Information Integration Application Service Center, to which qualified companies and institutions can submit applications for permission to analyze the bureau＇s collected disease data according to stipulated regulations. In effect, access to the center＇s data provides insurance companies with a further means of improving their operational effectiveness through the analysis of big data, with targets for potential improvements including the various strategies utilized to react to changes in the environment, such as those involved in marketing, administrative management, and product pricing and services. The foundation of the present study consisted of a literature review and survey, with the key objective being to determine and discuss the effects of big data analysis on the medical insurance industry, including the changes that the utilization of big data results in for the customers of medical insurance companies. With the issues discussed above in mind, the survey was designed to determine whether medical insurance consumers know about and understand the effects of big data. The survey data indicated the following key findings：（1） The two concepts exhibit clear differences in terms of population statistic wxiables; （2） The two concepts exhibit clear differences in terms of insurance purchasing variables; and （3） The two concepts exhibit clear differences in terms of the level of understanding regarding big da

关键词： big data medical insurance questionnaire survey

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The Enlightenment of EU Real-World Evidence Supporting the Inclusion of Rare Disease Drugs in medical insurance Decisions to China

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Asian Journal of Social Pharmacy 2021年第3期16卷 209-213页

作者： Yu Zhongyi Xu Fengxiang School of Business Administration Shenyang Pharmaceutical UniversityShenyang110016China Research Institute of Drug Regulatory Science Shenyang Pharmaceutical UniversityShenyang110016China

Objective To study the use of real-world evidence by EU and its member states for establishing a strategy for rare diseases and provide references for the inclusion of orphan drugs in China’s medical *** A case analysis method was used to introduce the EU’s decision to include rare disease drugs in medical insurance by using real-world evidence because clinical data of rare diseases were difficult to *** and Conclusion China can use real-world evidence to make medical insurance decisions based on the experience of the EU and continue to invest more in rare diseases,which can solve the problem of few drugs for patients with rare disease.

关键词： EU real-world evidence rare disease medical insurance

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The study of basic medical insurance system for urban residents in China

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International English Education Research 2017年第4期 60-62页

作者： GU Yanfang ZHANG Yushuai Hebei university College of Management Itebei Baoding071000

The basic medical insurance system for urban residents is an important part of China＇s social security *** article analyzes the problems which existing in the basic medical insurance system for urban residents and pu... 详细信息

关键词： Social security system Residents medical insurance

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Literature review of the basic medical insurance of urban and rural integration

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International English Education Research 2015年第8期 82-84页

作者： Liu Chang Shanghai university ofengineering science Shanghai China

To set up the nation＇s covering medical insurance syslem and to the realization of the basic medical insurance of urban and rural integration, is the inevitable trend in the development of China＇s medical insurance reform, as well as it is also a key step. In recent years, the state promulgated a series of policies in promoting urban and rural medical insurance and many cities took the lead to reform form the medical insurance pattern with local characteristics. All of these are helpful for our country to realize the integration and providing valuable experience. The target of the article is to maintain the public cause of medical and health, to solve the problem of high cost of urban and rural residents to see a doctor. As well as to realize the objections of disease pro^ection, convenience, cure spends less.

关键词： integration of urban and rural areas medical insurance experience for reference enlightenment

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Analysis of the effect of medical insurance on cancer inpatients: A 10-year retrospective study on a large hospital in Northeast China

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Oncology and Translational Medicine 2015年第6期1卷 284-288页

作者： Zhendong Zheng Lu Wang Quanwei Fu Tao Han Xiaodong Xie Department of medical Oncology The General Hospital of Shenyang Military Region Department of medical insurance The General Hospital of Shenyang Military Region

Objective The aim of the study was to analyze hospital costs for cancer inpatients availing different methods of payment and the influencing factors, to provide inputs to improve the medical insurance payment policy. Methods We analyzed the information related to length of hospital stay, hospitalization cost, and self-pay cost, collected from one large-scale, Grade A, Class Three hospital in Shenyang, China, during 2004–*** The number of cancer inpatients with different payment types(medical insurance group and non-medical insurance group) presented a rising trend. Further, the ratio of medical insurance inpatients increased rapidly(from 22.2% to 48.7%); however, this group was still a minority. The length of hospital stay became shorter(21 d vs. 17 d; P = 0.000) while the gap got narrower; the hospitalized expense showed an upward trend and the difference was remarkable($24048.6 ± $4376.28 vs. $20544.36 ± $4057.01; P = 0.000). Conclusion Along with normalization of cancer therapy, the influence of payment on treatment has been getting weak, the policy has impact on controlling hospitalization cost, lightening burden of cancer patient, as well as allocating medical resources in a reasonable way, becoming an important defray pattern of hospitalization cost.

关键词： medical insurance cancer inpatients retrospective study

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Inspiration of Foreign Innovative Drug Pricing Methods and medical insurance Payment Standards to China

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Asian Journal of Social Pharmacy 2023年第4期18卷 365-373页

作者： Rao Xiuli Sun Lihua School of Business Administration Shenyang Pharmaceutical UniversityShenyang 110016China Jiangxi Jemincare Group Co. Ltd.Nanchang 330096China

Objective To study the innovative drug pricing methods and medical insurance payment standards in foreign countries and to provide reference for China’s *** The official websites were searched for information and related literature,and literature review was *** and Conclusion In foreign countries,the clinical value of innovative drugs and their impact on medical insurance funds were comprehensively evaluated based on factors such as quality-adjusted life years,clinical benefit,and improvement of clinical ***,the evaluation results were taken as an important basis for whether innovative drugs were admitted to the medical insurance catalog and establishing medical insurance payment *** using international experience for reference,innovative drug pricing methods and medical insurance payment standards for China’s national conditions can be improved by establishing a basic database of clinical value and drug economic evaluation of innovative drugs,as well as innovative drug payment models based on decision thresholds.

关键词： innovative drug pricing method payment standard medical insurance international experience

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Research on Reimbursement Management of Innovative Drugs Abroad and Its Enlightenment to China

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Asian Journal of Social Pharmacy 2024年第1期19卷 1-8页

作者： Yu Hanshuang Huang Xianqin Wang Huiyan Sun Lihua School of Business Administration Shenyang Pharmaceutical UniversityShenyang 110016China School of Pharmacy Peking UniversityBeijing 100191China

Objective To analyze the reimbursement policies of innovative drugs in some developed countries,and to provide reference for future reimbursement management in *** Literature research method was used to study the policies related to the reimbursement management of innovative drugs in Germany,France and Japan,and their successful experience was *** and Conclusion China should establish an open and transparent value evaluation standard to improve the medical insurance reimbursement management of innovative ***,the value of innovative drugs should be taken as an important basis for reimbursement decisions,and an independent third-party value evaluation agency must be established.

关键词： innovative drug medical insurance reimbursement

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