CN109035034A - A kind of health insurance actuarial System and method for based on payment data - Google Patents
A kind of health insurance actuarial System and method for based on payment data Download PDFInfo
- Publication number
- CN109035034A CN109035034A CN201810598253.1A CN201810598253A CN109035034A CN 109035034 A CN109035034 A CN 109035034A CN 201810598253 A CN201810598253 A CN 201810598253A CN 109035034 A CN109035034 A CN 109035034A
- Authority
- CN
- China
- Prior art keywords
- user
- period
- payment
- payment data
- health insurance
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Pending
Links
- 238000000034 method Methods 0.000 title claims abstract description 22
- 201000010099 disease Diseases 0.000 claims abstract description 30
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 claims abstract description 30
- 238000000605 extraction Methods 0.000 claims abstract description 9
- 238000004364 calculation method Methods 0.000 claims description 4
- 239000000284 extract Substances 0.000 claims description 4
- 230000001447 compensatory effect Effects 0.000 claims description 3
- 230000002265 prevention Effects 0.000 claims description 3
- 230000006870 function Effects 0.000 description 3
- 238000010586 diagram Methods 0.000 description 2
- 238000005516 engineering process Methods 0.000 description 2
- PCHJSUWPFVWCPO-UHFFFAOYSA-N gold Chemical compound [Au] PCHJSUWPFVWCPO-UHFFFAOYSA-N 0.000 description 2
- 239000010931 gold Substances 0.000 description 2
- 229910052737 gold Inorganic materials 0.000 description 2
- 230000009897 systematic effect Effects 0.000 description 2
- 239000008186 active pharmaceutical agent Substances 0.000 description 1
- 238000004458 analytical method Methods 0.000 description 1
- 239000003814 drug Substances 0.000 description 1
- 230000004927 fusion Effects 0.000 description 1
- 230000005055 memory storage Effects 0.000 description 1
Classifications
-
- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
- G06Q40/08—Insurance
Landscapes
- Business, Economics & Management (AREA)
- Accounting & Taxation (AREA)
- Finance (AREA)
- Engineering & Computer Science (AREA)
- Development Economics (AREA)
- Economics (AREA)
- Marketing (AREA)
- Strategic Management (AREA)
- Technology Law (AREA)
- Physics & Mathematics (AREA)
- General Business, Economics & Management (AREA)
- General Physics & Mathematics (AREA)
- Theoretical Computer Science (AREA)
- Financial Or Insurance-Related Operations Such As Payment And Settlement (AREA)
- Medical Treatment And Welfare Office Work (AREA)
Abstract
The present invention relates to a kind of health insurance actuarial System and method for based on payment data, belongs to health insurance actuarial technical field.System of the invention includes processing module, obtains module, extraction module, computing module.Method of the invention is that the payment data of user is periodically obtained from payment information system according to the preset period；The medical payment data in user's corresponding i-th of period are extracted according to the payment data in i-th of period；According to the medical payment data in i-th of period of user, the disease incident in i-th of period of user is calculated；The health insurance premium in i-th of period of user is calculated according to the disease incident in i-th period of user and given health insurance actuarial algorithm.The present invention is based on the health insurance actuarial System and method fors of data payment, user is periodically understood in the cost of medical institutions in conjunction with user's payment data, and according to the period disease incident for spending calculating user, the risk of health insurance can be reduced, the profitability of insurance company can be improved.
Description
Technical field
The present invention relates to a kind of health insurance actuarial System and method for based on payment data, belongs to health insurance actuarial skill
Art field.
Background technique
China of today has come into the epoch of cashless payment, and wherein Alipay and wechat are most important two kinds of branch
The mode of paying.Due to the popularization of convenience and self-service equipment, more persons select by Web vector graphic Alipay, wechat or
Person directly uses bank card and credit card to carry out medical payment.
The processing analysis of big data is just becoming the node of generation information technology fusion application.Mobile Internet, Internet of Things,
E-commerce etc. is the application form of generation information technology, these applications constantly generate big data.Cloud computing mentions for big data
For storage and operation platform, people can be helped to extract from these magnanimity, diversified payment data related to health insurance
Data.
For Insurance Actuarial Science system at this stage when being analyzed and processed for medical data, there is no consideration users to use branch
Payment data caused by Fu Bao, wechat, bank card and credit card has ignored the medical treatment letter that medical payment big data includes
Breath also reduces the accuracy of health insurance actuarial risk profile, and then increases the risk of insurance company.
Summary of the invention
The object of the present invention is to provide a kind of health insurance actuarial System and method for based on payment data, it is existing to solve
It is not based on user in Insurance Actuarial Science system and uses payment big data caused by Alipay, wechat, bank card and credit card
The technical problems such as Insurance Actuarial Science are carried out, by the processing to medical big data, user's disease incident can be according to user's medical treatment branch
It pays data and carries out periodical adjustment, improve the accuracy of health insurance actuarial risk profile, reduce the Claims Resolution of health insurance
Risk, so that the higher profit that insurance company obtains.
The present invention is realized by following technical scheme: a kind of health insurance actuarial system based on payment data runs on number
According to center, it is characterised in that: the data center connect with payment platform information system and banking information system respectively, based on branch
The health insurance actuarial system for paying data includes processing module, obtains module, extraction module, computing module；Processing module, acquisition
Module, extraction module, computing module are sequentially connected, and processing module is used to the payment information of each user arranged respectively to corresponding
It in each set of user, obtains module and is used for according to predetermined period, periodically obtain generated payment when user's payment
Data, extraction module are used to extract the medical payment number in user's corresponding i-th of period according to the payment data in i-th of period
According to, computing module is used for the medical payment data according to i-th of period of user, the disease incident in i-th of period of user is calculated,
And i-th period of user is calculated according to the disease incident in i-th period of user and given health insurance actuarial algorithm
Health insurance premium.
A kind of health insurance calculating method based on payment data is applied to data center, it is characterised in that: the data
Center is connect with payment platform information system and banking information system respectively, and the specific method is as follows:
Step 1: periodically obtaining the payment data of user from payment information system according to the preset period；
Step 2: extracting the medical payment data in user's corresponding i-th of period according to the payment data in i-th of period；
Step 3: calculating the disease incident in i-th of period of user according to the medical payment data in i-th of period of user；
Step 4: calculating use according to the disease incident in i-th period of user and given health insurance actuarial algorithm
The health insurance premium in i-th of period of family.
The predetermined period is 1 year, 2 years or 3 years, and the payment data includes address name, payment accounts, connection
Mode, age, gender, date and pay content information.
The disease incident calculation formula are as follows:Wherein, piFor user's disease incident in i-th of period, mi
For i-th of cycle user medical payment total value, niFor i-th of cycle user payment data total value.
The given health insurance actuarial algorithmic formula are as follows: S=A+B+C+D, A=A1 × (1+k+pi)×A2×A3,
A2=1+A21, wherein S is health insurance premium；A is medical compensatory expense；B is that prevention and health care takes；C is administration fee；D is deposit
Gold；A1 is medical fee base-line data；A2 is Insurance factor；A3 is compensation ratio；piFor the disease incident in i-th of period；Formula
Middle parameter B, C, D, A1 and A3 are fixed value, and A21 is the increment rate of Health service utilization.
The invention has the following advantages: the health insurance actuarial System and method for based on data payment, in conjunction with user
Pay number
According to periodically understand user medical institutions cost, and according to it is described spend calculate user period disease send out
Raw rate,
The profitability of insurance company can be improved in the risk that health insurance can be reduced.
Detailed description of the invention
Fig. 1 is the health insurance actuarial systematic difference environment schematic the present invention is based on payment data；
Fig. 2 is the functional block diagram of the health insurance actuarial system the present invention is based on payment data；
Fig. 3 is the flow chart of the health insurance calculating method the present invention is based on payment data.
Specific embodiment
With reference to the accompanying drawings and examples, the invention will be further described, but the contents of the present invention be not limited to it is described
Range.
Fig. 1 is the health insurance actuarial systematic difference environment schematic the present invention is based on payment data, based on payment number
According to health insurance actuarial system run on data center, since the means of payment of user of the present invention only selects bank card, credit
Card, Alipay and wechat, therefore the payment information system includes banking information system and payment platform information system.
The data center is connect by network with banking information system and payment platform information system.
The banking information system is connect by bank card or credit card with A class user.
The payment platform information system is connect by client with B class user.
It is other that the client may be, but not limited to, smart phone, tablet computer, laptop, desktop computer etc.
Any appropriate electronic equipment with network connecting function.
The banking information system records generated payment data when A class user pays by bank card or credit card,
And payment data can be sent to data center, when the payment platform information system records B class user payment by client
Generated payment data, and payment data can be sent to data center.
The payment data includes address name, payment accounts, contact method, age, gender, date and pay content letter
Breath.
It should be noted that since the payment data belongs to privacy information, to ensure information security, payment information system
When the payment data is sent to data center, can by enciphering and deciphering algorithm (such as: MD5 enciphering and deciphering algorithm, RSA enciphering and deciphering algorithm,
DES enciphering and deciphering algorithm etc.) first payment data is encrypted, it is transferred to data center later.
It should be noted that A class user of the present invention refers to the user paid using bank card and credit card, but
Do not limit to A class user to pay using Alipay and wechat；Similarly, B class user of the present invention refer to using Alipay and
The user that wechat is paid, but do not limit to B class user and paid using bank card and credit card.
Fig. 2 is the functional block diagram of the health insurance actuarial system the present invention is based on payment data.The functional module includes,
But it is not limited only to, processing data module obtains data module, extracts data module, calculates data module, processing module, acquisition
Module, extraction module, computing module are sequentially connected, and processing module is used to the payment information of each user arranged respectively to corresponding
It in each set of user, obtains module and is used for according to predetermined period, periodically obtain generated payment when user's payment
Data, extraction module are used to extract the medical payment number in user's corresponding i-th of period according to the payment data in i-th of period
According to, computing module is used for the medical payment data according to i-th of period of user, the disease incident in i-th of period of user is calculated,
And i-th period of user is calculated according to the disease incident in i-th period of user and given health insurance actuarial algorithm
Health insurance premium.
The functional module is stored in the storage unit of data center, and data center is in cloud platform or cloud platform
A certain server, storage unit can be a kind of read-only memory unit ROM, electrically-erasable storage unit EEPROM and flash memory
Storage unit FLASH etc..
Signified module of the invention refers to that one kind can be executed and can be completed by the processing unit of the data center
The series of computation machine program instruction section of fixed function, the processing unit can be a kind of central processing unit, microcontroller, data
Handle chip or information process unit having data processing function.
The processing data module is used to handle to be transmitted in data by banking information system and payment platform information system
User's payment data of the heart.
The processing data module is that the banking information system of each user is transmitted respectively with payment platform information system
To the unified arrangement of user's payment data of data center, it is put into the payment information set of corresponding each user, the set local
In the storage unit of data center.
It should be noted that the banking information system and payment platform information system provide api interface, the API is accessed
The equipment or system of interface all can therefrom obtain the payment data, and the acquisition data module passes through the banking information system
The api interface provided with payment platform information system is to obtain the payment data.
The acquisition data module is used for from processing data module treated the data acquisition system, according to default week
Phase periodically obtains the payment data that user generates.
The data module of extracting is used for from obtaining in the obtained user's payment data of data module, according to predetermined period,
Periodically obtain the medical payment data that user generates.
Specifically, being had due to including pay content in the payment data according to what is be related to the pay content
The data for closing Medical Consumption (such as: registering, buy medicine, medical equipment etc.) extract, the medical payment data as user.
When the calculating data module is used to all extract the medical payment data, the disease incident is calculated.
Specifically, the calculation formula of the disease incident are as follows:Wherein, piFor user's disease in i-th of period
Sick incidence, miFor i-th of cycle user medical payment total value, niFor i-th of cycle user payment data total value.
Fig. 3 is the flow chart of the health insurance calculating method the present invention is based on payment data.This method is specifically such as:
Step 1: periodically obtaining the payment data of user from payment information system according to the preset period；
Step 2: extracting the medical payment data in user's corresponding i-th of period according to the payment data in i-th of period；
Step 3: calculating the disease incident in i-th of period of user according to the medical payment data in i-th of period of user；
Step 4: calculating use according to the disease incident in i-th period of user and given health insurance actuarial algorithm
The health insurance premium in i-th of period of family.
The predetermined period is 1 year, 2 years or 3 years, and the payment data includes address name, payment accounts, connection
Mode, age, gender, date and pay content information.
The disease incident calculation formula are as follows:Wherein, piFor user's disease incident in i-th of period, mi
For i-th of cycle user medical payment total value, niFor i-th of cycle user payment data total value.
The given health insurance actuarial algorithmic formula are as follows: S=A+B+C+D, A=A1 × (1+k+pi)×A2×A3,
A2=1+A21, wherein S is health insurance premium；A is medical compensatory expense；B is that prevention and health care takes；C is administration fee；D is deposit
Gold；A1 is medical fee base-line data；A2 is Insurance factor；A3 is compensation ratio；piFor the disease incident in i-th of period；Formula
Middle parameter B, C, D, A1 and A3 are fixed value, and A21 is the increment rate of Health service utilization.
It should be noted that health insurance actuarial algorithm of the present invention can also be it is other it is existing include disease
The Insurance Actuarial Science algorithm of rate.
The above is only a preferred embodiment of the present invention, is not intended to limit the scope of the invention, all to utilize this hair
Equivalent structure or equivalent flow shift made by bright specification and accompanying drawing content is applied directly or indirectly in other relevant skills
Art field is included in scope of patent protection of the invention.
Claims (5)
1. a kind of health insurance actuarial system based on payment data, runs on data center, it is characterised in that: in the data
The heart is connect with payment platform information system and banking information system respectively, and the health insurance actuarial system based on payment data includes
Processing module obtains module, extraction module, computing module；Processing module, acquisition module, extraction module, computing module successively connect
It connects, processing module is used to the payment information of each user arranged in each set of relative users respectively, obtains module and uses
It is used according to predetermined period, periodically obtaining generated payment data, extraction module when user's payment according to i-th week
The payment data of phase extracts the medical payment data in user's corresponding i-th of period, and computing module is used for according to user i-th week
The medical payment data of phase calculate the disease incident in i-th of period of user, and are occurred according to the disease in i-th of period of user
Rate and given health insurance actuarial algorithm calculate the health insurance premium in i-th of period of user.
2. a kind of health insurance calculating method based on payment data is applied to data center, it is characterised in that: in the data
The heart is connect with payment platform information system and banking information system respectively, and the specific method is as follows:
Step 1: periodically obtaining the payment data of user from payment information system according to the preset period；
Step 2: extracting the medical payment data in user's corresponding i-th of period according to the payment data in i-th of period；
Step 3: calculating the disease incident in i-th of period of user according to the medical payment data in i-th of period of user；
Step 4: calculating user i-th according to the disease incident in i-th period of user and given health insurance actuarial algorithm
The health insurance premium in a period.
3. the health insurance calculating method according to claim 2 based on payment data, it is characterised in that: the default week
Phase is 1 year, 2 years or 3 years, and the payment data includes address name, payment accounts, contact method, age, gender, date
And pay content information.
4. the health insurance calculating method according to claim 2 based on payment data, it is characterised in that: the disease hair
Raw rate calculation formula are as follows:Wherein, piFor user's disease incident in i-th of period, miIt is cured for i-th of cycle user
Treat total payment, niFor i-th of cycle user payment data total value.
5. the health insurance calculating method according to claim 2 based on payment data, it is characterised in that: described given
Health insurance actuarial algorithmic formula are as follows: S=A+B+C+D, A=A1 × (1+k+pi) × A2 × A3, A2=1+A21, wherein S is
Health insurance premium；A is medical compensatory expense；B is that prevention and health care takes；C is administration fee；D is reserve fund；A1 is medical fee baseline number
According to；A2 is Insurance factor；A3 is compensation ratio；piFor the disease incident in i-th of period；Parameters in Formula B, C, D, A1 and A3 are
Fixed value, A21 are the increment rate of Health service utilization.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201810598253.1A CN109035034A (en) | 2018-06-12 | 2018-06-12 | A kind of health insurance actuarial System and method for based on payment data |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201810598253.1A CN109035034A (en) | 2018-06-12 | 2018-06-12 | A kind of health insurance actuarial System and method for based on payment data |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CN109035034A true CN109035034A (en) | 2018-12-18 |
Family
ID=64612735
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201810598253.1A Pending CN109035034A (en) | 2018-06-12 | 2018-06-12 | A kind of health insurance actuarial System and method for based on payment data |
Country Status (1)
| Country | Link |
|---|---|
| CN (1) | CN109035034A (en) |
Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN111145032A (en) * | 2019-11-25 | 2020-05-12 | 泰康保险集团股份有限公司 | Method and device for generating insurance payment page, electronic equipment and readable storage medium |
| CN113011988A (en) * | 2021-02-20 | 2021-06-22 | 北京爱选信息科技有限公司 | Insurance actuarial system based on big data |
| CN113011987A (en) * | 2021-02-20 | 2021-06-22 | 北京爱选信息科技有限公司 | Insurance actuarial method based on big data |
Citations (8)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN102163307A (en) * | 2011-04-08 | 2011-08-24 | 常州谐筑信息科技有限公司 | Medical insurance claims management method |
| CN105809552A (en) * | 2016-03-10 | 2016-07-27 | 深圳市前海安测信息技术有限公司 | Insurance actuarial system and method based on search keywords |
| CN105825429A (en) * | 2016-03-18 | 2016-08-03 | 深圳市前海安测信息技术有限公司 | Actuarial approach and system based on medical big data |
| CN105844527A (en) * | 2016-03-18 | 2016-08-10 | 深圳市前海安测信息技术有限公司 | Medical insurance premium discount actuarial system and method |
| CN105844093A (en) * | 2016-03-19 | 2016-08-10 | 深圳市前海安测信息技术有限公司 | Social data based actuarial system and method |
| CN107622801A (en) * | 2017-02-20 | 2018-01-23 | 平安科技（深圳）有限公司 | The detection method and device of disease probability |
| CN107767009A (en) * | 2017-06-29 | 2018-03-06 | 平安医疗健康管理股份有限公司 | Medical Benefits Fund actuarial Forecasting Methodology and device |
| CN107967948A (en) * | 2017-12-07 | 2018-04-27 | 泰康保险集团股份有限公司 | Medical big data analysis method and apparatus |
-
2018
- 2018-06-12 CN CN201810598253.1A patent/CN109035034A/en active Pending
Patent Citations (8)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN102163307A (en) * | 2011-04-08 | 2011-08-24 | 常州谐筑信息科技有限公司 | Medical insurance claims management method |
| CN105809552A (en) * | 2016-03-10 | 2016-07-27 | 深圳市前海安测信息技术有限公司 | Insurance actuarial system and method based on search keywords |
| CN105825429A (en) * | 2016-03-18 | 2016-08-03 | 深圳市前海安测信息技术有限公司 | Actuarial approach and system based on medical big data |
| CN105844527A (en) * | 2016-03-18 | 2016-08-10 | 深圳市前海安测信息技术有限公司 | Medical insurance premium discount actuarial system and method |
| CN105844093A (en) * | 2016-03-19 | 2016-08-10 | 深圳市前海安测信息技术有限公司 | Social data based actuarial system and method |
| CN107622801A (en) * | 2017-02-20 | 2018-01-23 | 平安科技（深圳）有限公司 | The detection method and device of disease probability |
| CN107767009A (en) * | 2017-06-29 | 2018-03-06 | 平安医疗健康管理股份有限公司 | Medical Benefits Fund actuarial Forecasting Methodology and device |
| CN107967948A (en) * | 2017-12-07 | 2018-04-27 | 泰康保险集团股份有限公司 | Medical big data analysis method and apparatus |
Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN111145032A (en) * | 2019-11-25 | 2020-05-12 | 泰康保险集团股份有限公司 | Method and device for generating insurance payment page, electronic equipment and readable storage medium |
| CN113011988A (en) * | 2021-02-20 | 2021-06-22 | 北京爱选信息科技有限公司 | Insurance actuarial system based on big data |
| CN113011987A (en) * | 2021-02-20 | 2021-06-22 | 北京爱选信息科技有限公司 | Insurance actuarial method based on big data |
Similar Documents
| Publication | Publication Date | Title |
|---|---|---|
| D’Silva et al. | The design of digital financial infrastructure: lessons from India | |
| Fernandes et al. | The contribution of digital financial services to financial inclusion in Mozambique: an ARDL model approach | |
| US20160253731A1 (en) | Network-based marketplace service for facilitating purchases of bundled services and products | |
| CN109035034A (en) | A kind of health insurance actuarial System and method for based on payment data | |
| Medyawati et al. | Financial technology as determinants of bank profitability | |
| CN102364516A (en) | Method and system for authenticating payment information of integrated circuit (IC) social security card | |
| US20210374872A1 (en) | Variable copay system | |
| KR20230080879A (en) | System and method for rewarding for physical activity based on block chain | |
| CN110335133A (en) | Processing method, system, electronic equipment and the storage medium of transaction data | |
| Raja | Global e-banking scenario and challenges in banking system | |
| US11955215B2 (en) | Data processing system for processing network data records transmitted from remote, distributed terminal devices | |
| US20160196591A1 (en) | System and method for making and tracking charitable contributions | |
| CN114723568A (en) | Recommendation method, device, server, medium and product for financial product | |
| US20210090078A1 (en) | Systems and methods for authentication based on user activity | |
| Pratiwi et al. | The Role of Digital Consumer Protection in Mediating the Effect of Mobile Money usage towards Financial Inclusion: an Evidence from Buleleng, Indonesia | |
| Arya | E-Banking: The Emerging Trend | |
| US11087370B2 (en) | System and method for administering charitable auctions | |
| KR101892188B1 (en) | Method, apparatus and computer-readable medium for providing payment service, and computer program for executing method for obtaining payment page | |
| US11682494B2 (en) | Method and apparatus for generating health indicator data | |
| US20220415460A1 (en) | Digital Healthcare Capture Intake Data for COVID-19 And Other Significant Events | |
| Chawla | Exploring The Potential Of Online Banking: An Insight Into Innovations And Barriers In The Indian Context | |
| RU150873U1 (en) | TERMINAL FOR INDEPENDENT IMPLEMENTATION OF TRANSACTIONS, PREFERREDLY FOR RECEIPT OF LOANS AND / OR LOANS | |
| Gaikwad et al. | Online Banking in India–Advantages & Disadvantages | |
| Desai et al. | Influence of gender on satisfaction level with the services of online banking-A study with reference to Surat city | |
| JP2024001929A (en) | Information processing method, information processing apparatus, and program |
Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| PB01 | Publication | ||
| PB01 | Publication | ||
| SE01 | Entry into force of request for substantive examination | ||
| SE01 | Entry into force of request for substantive examination | ||
| WD01 | Invention patent application deemed withdrawn after publication |
Application publication date: 20181218 |
|
| WD01 | Invention patent application deemed withdrawn after publication |